Workers' Compensation Information for Injured Workers
I've Been Injured. What Do I Do?
You've been injured on the job. You may still be on the job, or your injury might prevent you from working now. You may have already filled out a “First Report” or “Notice of Injury.” So, what happens now?
Workers' compensation is different in every state. How you get money and medical treatment will depend on either where you live or where the injury took place. This information explains basic elements of workers' compensation. It is not legal advice.
If you have not notified your employer of your injury, do so immediately. The longer you wait, the harder it may be to get benefits. Also, reporting delays may increase the chance your claim will be investigated or denied. Write down contact information for anyone who saw the accident or who can describe what happened.
Your employer cannot fire you for filing a claim or tell you not to file a claim. If that happens, notify the state or talk to an attorney. Here is an area where you can find a list of state workers' comp agency phone numbers.
Workers' compensation in most states is considered a no fault “exclusive remedy.” That means that, in most cases, your employer will provide basic medical and lost wage benefits whether the injury was your fault or not. In exchange, you can not sue your employer for what is known as tort liability. That includes negligence, pain and suffering, loss of consortium, etc. In most cases, the law restricts you to the benefits defined by the state where your accident occurred.
You are entering a complex system with many moving parts. No one will be a better advocate for your healing and recovery than you. Your best course of action is to stay engaged, ask questions and take ownership in your care.
You will likely be assigned a “claims adjuster” who works for your employer, an insurance company, or a “Third Party administrator” or TPA. A TPA is a firm paid to manage injury incidents like yours. Claims adjusters in the U.S. generally handle many cases. They may have more than 200 “files” (injury cases) to manage at a single time. That means they may not be able to return your call as quickly as you would like, and it may at times be difficult to communicate with them. If they are simply not responding, you may want to seek out a supervisor with that company.
Keep your employer informed about what is happening with your injury, especially if you are out of work because of it. Employers are sometimes not the best at communicating when you are off the job, so being proactive may help you get what you need.
What if your claim is denied or investigated? This may happen if nobody saw your injury happen or if your condition resulted from a cumulative (over time) soft tissue or “invisible” injury. In some states, insurers have a set amount of time to either accept or deny a claim, and that may make an initial denial likely. If they are unsure, or need time to investigate, they may simply deny the claim to get more time. If that occurs, it is your responsibility to appeal the decision, or that investigation will likely not happen. Insurers can reverse their denial when evidence supports it; in many cases they cannot refuse a claim once it has been accepted even if later evidence shows the injury is not work related.
To appeal a denial, you should try to get a reason for the denial from the insurance carrier. Some states have employees, called Ombudspersons, who can help you with this. Sometimes providing more supporting information (witness names, etc.) to the adjuster may help. You may also consult with an attorney who specializes in workers' compensation.
Once your claim is accepted, this may still be a slow and frustrating process. Simple steps, such as being on time for all doctors' appointments and clearly communicating information to your adjuster, employer, and others may help this process. The carrier may also assign other people, such as Nurse Case Managers and Vocational Specialists, to assist you in recovery.
More state specific information will be coming to this area soon, provided in partnership with the International Association of Industrial Accident Boards and Commissions (IAIABC).
For additional information:
You may find our Injured Workers Discussion Forum helpful. It is available here.
You may find state laws, regulations and useful contact numbers here.