Maximizing your workers’ compensation benefits is critical to receiving the full care and reimbursement you deserve following a workplace injury.
Workers’ compensation is intended to help employees cover medical bills, missed income, and rehabilitation expenditures, but many people are unsure how to handle the claims process effectively. Understanding your rights and the actions involved will help you avoid frequent mistakes and maximize your rewards.
Every step you take, from filing claims on time to getting medical treatment from recognized providers, might affect the result of your case.
Taking a few strategic actions can prevent delays and disagreements while ensuring you obtain the financial and medical support you require for rehabilitation.
1. Immediately report your injury
The first thing you should do following a workplace injury is notify your manager. Every state mandates workers to report their injuries by a specific deadline, which varies greatly by state. You may forfeit your right to receive workers’ compensation payments if you miss the deadline. In some areas, you must also file a workers’ compensation claim form by a specific deadline to begin your claim officially. Please see our page on filing workers’ compensation claims to learn more about these criteria.
2. Receive prompt medical treatment
You must seek medical attention as soon as possible after being injured. Prompt medical intervention can result in a faster, more complete recovery. It also provides valuable medical proof in your workers’ compensation claim by recording your accident and explaining your injuries and physical limitations. If you postpone seeking care, the insurance company may argue that you were not as gravely hurt as you claim—or that the injury never occurred.
3. Consider hiring a workers’ compensation lawyer
You may not need a lawyer if your workers’ compensation claim is uncomplicated or the insurance company agrees to pay your claim.
However, consider hiring an expert workers compensation lawyer if the insurance company:
- Reduces or refuses your benefits.
- Makes a settlement offer.
- Rejects your claim and asks for information.
Navigating the workers’ compensation system can be complicated, especially when to accept a settlement offer and for how much. A lawyer can accurately estimate your claim, negotiate with the insurance company, and, if required, represent you on appeal.
4. Understand available workers’ compensation benefits
Injured workers should comprehend the benefits offered through the workers’ compensation system. While each state has its criteria for eligibility and amounts, the following benefits are often available:
- Temporary disability benefits are paid while you are off work and recovering from your injury.
- Permanent disability benefits compensate for long-term physical limitations induced by the injury.
- Medical treatment: appropriate and essential medical care for your injuries.
- Vocational rehabilitation: employment retraining and other assistance in finding a job within your work constraints. and
- Mileage is remuneration for travel to and from doctor’s appointments and other work-related travel.
Because insurance firms are for-profit corporations, you should not expect the adjuster to thoroughly explain your state’s benefit scheme or all applicable benefits.
5. Prepare for independent medical examinations
Unlike a conventional doctor’s consultation, an independent medical examination (IME) is not intended to treat your injury. Instead, the insurance company employs a doctor to examine, evaluate your medical data, and write a report. This report includes the doctor’s assessment of your diagnosis, work restrictions, and the link between your injury and your job. Insurance companies frequently schedule IMEs to terminate or reduce your workers’ compensation coverage.
6. Avoid surveillance and private investigators
If the insurance company disputes your veracity, it may engage a private investigator to follow you around. The investigator will monitor you at home and in public, attempting to catch you doing something that contradicts your workers’ compensation claim. For example, imagine you inform your doctor that you cannot lift more than five pounds.
If a surveillance film shows you lugging boxes inside your home, the insurance company will use it to claim you are lying about your symptoms. However, the footage is readily misinterpreted—the boxes may be lighter than they appear, or you may have suffered significantly increased discomfort.
7. Maintain detailed medical and work records
It’s usually a good idea to save copies of any information related to your workers’ compensation claim, such as work limitations, letters from your employer or insurance company, and completed forms. While your doctors will develop medical documents to track your treatment, work restriction slips are not usually included in those records. Many of these data are required to get your workers’ compensation claim authorized and reimbursed.
8. Consider appealing a denial of workers’ compensation benefits
Insurance companies are for-profit corporations. They regularly dismiss valid workers’ compensation claims to save money. However, you have the right to dispute the insurance company’s denial.
While each state’s process and standards vary, an appeal often includes filing a written form with the state agency by a specific time. After the state agency files your appeal, a judge will usually schedule one or more hearings to evaluate and settle your case. Workers’ compensation appeals are hard and involve substantial legal and technical understanding, so you should consider hiring a lawyer now. (For additional information, see our article about workers’ compensation appeals.
9. Consider changing doctors.
Many states require workers to see a doctor their insurance provider chooses. When you see the insurance company’s doctor, there is a possible conflict of interest. Insurance corporations primarily compensate these physicians and may not always have your best interests at heart. For example, the doctor may minimize your injuries and treatment so that the insurance company does not have to spend as much.
Because your treating doctor will play an important part in your workers’ compensation case, you should consider switching doctors if you believe you are not receiving the best care. Each state has unique rules and procedures for changing doctors, which vary considerably. For example, there may be a waiting time before switching, or you may be limited to one move during your workers’ compensation claim term.
In the end!
Maximizing your workers’ compensation benefits involves meticulous attention to detail and a proactive mindset. Understanding your rights, recording everything thoroughly, and working with skilled professionals will help you get the compensation you deserve. Timely reporting, proper medical care, and good contact with your employer and insurance carrier are necessary for a successful claim. These steps will allow you to focus on your recovery while minimizing financial stress.
