Workers’ compensation is insurance that covers injured workers. Most employers carry this insurance, and it helps pay for expenses related to injuries that occur while on the job.
To file a claim, there are certain steps that an injured employee must take. If the insurance company denies the claim, there is an appeals process.
Workers’ compensation benefits
According to the U.S. Department of Labor, employees that can file a workers’ compensation claim are those that receive an injury at work or develop an illness due to the nature of the job. Benefits cover expenses related to medical treatment and missed wages, and additional benefits include vocational rehabilitation, permanent disability compensation and survivor benefits.
How to file a claim
If injured on the job, FindLaw states that it is important to notify the employer about the incident as soon as possible. The injured worker should also seek medical treatment right away. When filing the claim, the injured party must include the date and time the injury occurred, the type and location of the injury, how the injury occurred, the treatment received and if there was involvement of other parties. The worker should include any supporting documents, such as medical records, details about how the injury affects daily activities and witness testimonies.
Common reasons for claim denials
If the insurance company or employer denies the claim, the denial letter will state why. Common reasons include:
- The injury did not occur at work
- The injury was a result of alcohol or drug use
- It was a self-inflicted injury
- The worker did not receive medical treatment or did not follow the treatment plan
- There is not enough evidence that the injury prevents the employee from working
If the worker thinks there is a valid reason for the claim, the denial letter will explain how to appeal the decision.
