Most of my clients have never had a workers' compensation claim before, and frankly, the system is extremely complicated. On the other hand, the employers, and especially those in the human resources department are extremely knowledgeable about this process.
Upon getting injured, report your injury to your supervisor as quick as possible. You must do so within 30 days, with few exceptions. You should then have your employer fill out a report of injury, which you are entitled to a copy of. If you need medical assistance, request the Panel of Physicians, which typically has six or more doctors from which you are entitled to choose from. If you have questions about whom to see, please call me. If your employer does not have a Panel, you are entitled to see anyone whom you choose. PLEASE NOTE HOWEVER: If your injury is an emergency, please proceed immediately to an Emergency Room, which is allowed under Workers’ Compensation rule and regulations.
After your initial treatment, keep in contact with your supervisor or the designated workers' compensation representative about your treatment. If your injury is severe enough, you may be placed under work restrictions, which the employer must comply with if they expect you to return to work. If they cannot accommodate those restrictions, or if they have to reduce your hours and/or pay due to the restrictions, are you entitled to temporary partial disability (TPD) benefits equal to 2/3 the difference between your pre-and post-injury weekly wage, up to $334/week. If your doctor tells you that you cannot work at all, then you are entitled to temporary total disability benefits (TTD), which equates to 2/3 of your pre-injury wage, up to a maximum of $500/week.
Just because your employer or the insurance adjuster says you are not entitled to benefits, this is not necessarily the case. This is why you need an experienced attorney to handle your claim. This is especially true if you cannot work due to your injury, yet your employer says you should. This could also be true if you were fired shortly after your accident, even if the employer says that your termination has nothing to do with that accident.
If the insurance company will not provide you with income and medical benefits, and often they do not, it may then be necessary to file a WC-14 Request for Hearing. That is a proceeding where you are allowed to tell your story to an Administrative Law Judge (ALJ) assigned to your claim. Your supervisor or someone else from your employer may also appear to testify. Then, a detailed Post-Hearing Brief to the ALJ will be due, arguing why your benefits are due.
There are many other twists and turns in the complicated Workers' Compensation rule, but a few that the average first-time injured worker may not know about are especially important. First, if you become unhappy with your doctor, you are entitled to make a change to a different Panel physician one time. Second, if have received any income benefits, you are entitled to a second opinion Independent Medical Examination within 120 days of your last benefits being paid, to be paid for by the employer. Finally, for any authorized medical treatment, you are either entitled to reimbursement for your mileage, or you are entitled to round-trip transportation from your home. Again however, there are numerous obscure rules, so it is important to consult with an attorney.