How to File a Workers Comp Insurance Claim

You fall at work and sprain your ankle. You have chronic back pain due to overuse or misuse for an extended period of time while doing your job. You have developed lung cancer or some other disease or illness as a result of your work conditions. Any of these scenarios are cause for filing a workers compensation insurance claim.

Things You'll Need

• Claim Form
• Doctor's report

Instructions

1. Visit a doctor. Seek medical attention immediately, even if your injury or illness doesn't seem serious. Minor injuries can often turn into something more and a physician must verify any workers compensation claim.

2. Inform your employer. Formally record your injury and initiate a claim. Forms are available online, from your state Workers Compensation office or the United States Department of Labor.

3. Know what's covered. Most on-the-job injuries are covered. Exceptions are injuries sustained due to intoxication or illegal drug use; self-inflicted injuries; injuries sustained in the commission of a crime; those suffered when the employee was off duty; and any injuries incurred when a company policy was being violated.

4. Anticipate time constraints. Some states have time limits regarding when your employer is notified and a claim is filed.

5. Get a second opinion. It is customary for your employer's insurance company to require you to see their doctor. After examination, a recommendation for benefit payment will be made. Benefits may include roughly two-thirds of your regular income (tax-free), medical expenses and vocational rehabilitation.

6. Appeal a claim. If your claim is disputed, a hearing before the Workers Compensation Board may be requested. If that proves unsuccessful, your case may be brought before the Workers Compensation Administrative Law Judge.

7. Seek legal assistance. Legal representation may be needed if your case is complex. If you cannot afford it, free legal help is available.

Tips & Warnings

• You may be entitled to receive long-term or lump-sum benefits if you become permanently disabled or have dependents. Payment is dependent on the nature and extent of injuries.

• If it appears that you will be permanently disabled, contact your local Workers Compensation office immediately because these benefits take longer to process.

• If you are permanently unable to return to work you may be eligible for Social Security Disability Benefits.