So you want the real scoop on workers’ compensation?
Suffering an injury on the job is a bad enough experience. But when your employer and their insurance company start fighting you on your claim, it can become downright overwhelming. Every injured worker has a right to know their rights. It’s also important to know what an employer is required to do after an employee gets hurt on the job.
The problem is, most workers never know how the system really works until it’s too late. By then, mistakes may have already been made that can damage their case.
The good news is, this book will reveal everything you need to know about the workers’ comp system to avoid those mistakes. Let’s take a look.
What you will learn…
- How workers’ compensation really works
- Your essential rights as an injured worker
- What an employer must do (and often doesn’t)
- Why claims get denied and how to fight back
How Workers’ Compensation Really Works
Workers’ comp is designed to be simple…
You get hurt on the job, you file a claim, and your medical bills and lost wages get paid. The reality is far different, and far more complicated.
The truth is, workers’ compensation is a no-fault system. You don’t need to prove that your employer or co-worker was negligent to get benefits. You only need to show that your injury was work-related.
But here’s the catch… Even though it’s a no-fault system, 20% of workers’ compensation claims get denied each year. That’s why it’s critical to have a skilled workers comp lawyer in Fresno to protect your rights and get the benefits you deserve.
You might also be wondering what benefits you’re entitled to in a workers’ comp case. The typical benefits include:
- Medical expenses – All reasonable and necessary treatment
- Lost wages – Usually about two-thirds of your regular salary
- Permanent disability benefits – If you have lasting effects
- Vocational rehabilitation – If you can’t return to your old position
- Death benefits – For your family if the worst occurs
The average workers’ compensation claim costs $44,179. And that’s just the average.
Your Essential Rights as an Injured Worker
Did you know that most workers don’t even know what rights they have?
Employers? They certainly won’t be volunteering that information. Let’s break down what you’re entitled to under the law:
- Right to immediate medical care – You can seek emergency treatment as soon as possible. Your employer can’t make you wait for approval if it’s an emergency.
- Right to choose your doctor – In many states, you’re allowed to pick your own doctor after a certain period of time has elapsed. Don’t let your employer bully you into only seeing their “approved” doctors.
- Right to file a claim without retaliation – Your employer cannot retaliate against you for filing a workers’ comp claim. Retaliation includes firing, demoting, suspending, or otherwise punishing you. That’s illegal.
- Right to legal representation – You can hire an attorney at any time. In most workers’ comp cases, your attorney’s fees come out of the insurance company, not your pocket.
The most important right of all is…
The right to appeal. If your claim is denied, you don’t have to accept that decision.
What Employers Must Do (And Often Don’t)
As soon as an employee gets hurt, the employer has specific legal responsibilities…
But let’s be real – many employers will try to weasel out of those responsibilities as much as possible. Here’s what they are, and what they should be doing for you.
Employers Must Provide Workers’ Compensation Insurance
Let’s get this out of the way first. Employers are required by law to provide workers’ compensation insurance for their employees. That means every single employer, no exceptions.
It’s also not optional for the employee. Employers are not allowed to require you to pay any part of the premium or have you sign a waiver to avoid buying workers’ comp coverage.
If your employer doesn’t have coverage?
It’s a big deal, but there are special funds set aside to cover you.
Employers Must Report Your Injury Promptly
Reporting a workplace injury is a serious responsibility your employer has. Once your employer has notice of your injury, they must:
- Give you a claim form within one working day
- Report the injury to their insurance company immediately
- Authorize up to $10,000 in medical treatment on the spot
Failure to meet any of these reporting deadlines can cause significant legal problems for your employer.
Employers Must Not Intimidate or Retaliate
Your employer cannot:
- Pressure you not to file a claim
- Tell you it’s “just a minor injury” when it’s not
- Try to make you use your own health insurance instead
- Threaten your job if you file a claim
What really happens: Many employers will do everything they can to dissuade you from filing a claim. They might offer to pay your medical bills themselves, or ask you to use sick leave or vacation time instead.
Don’t fall for it.
Common Claim Denials and How to Fight Back
Your workers’ compensation claim should not be denied…
Insurers deny claims for all kinds of reasons, some legitimate and many not. These are the most common types of denials, and how to counter them:
“Your Injury Isn’t Work-Related”
This is probably the most common reason for a denied claim. The insurance company will say your injury occurred outside of work or resulted from a pre-existing condition.
How to fight it: Get detailed medical records that clearly establish a connection between your injury and work activities. A pre-existing condition doesn’t disqualify you from workers’ comp benefits. It only means the work injury aggravated that condition.
“You Didn’t Report the Injury on Time”
Most states require that you report an on-the-job injury within a certain number of days, usually between 30 and 90.
How to fight it: Document, document, document. Keep records of the date you first reported the injury to your supervisor and the date you first sought medical treatment. If there was a delay, make a note of the reason.
“Insufficient Medical Evidence”
The insurance company claims that there’s not enough medical evidence to prove that you’re injured.
How to fight it: Get detailed medical records. Make sure that every doctor you see knows it’s a work-related injury and records it that way.
The Appeals Process
Claim denials are not the end of the road. In fact, most claims that are initially denied end up getting approved after the appeals process.
The typical appeals process is as follows:
- Request a hearing before your state’s workers’ compensation board
- Gather additional evidence, such as medical records, witness statements, etc.
- Present your case to an administrative judge
- Receive a legally binding decision
This is where an experienced legal team becomes crucial.
Wrapping It All Together
Workers’ compensation isn’t a nice “benefit” your employer provides for you. It’s a legal right you’re entitled to when you get hurt on the job.
Knowing what you’re entitled to and what your employer is legally required to do can make all the difference between getting the benefits you deserve and getting stuck with medical bills and lost wages.
Remember these key points:
- You do not need to prove fault to receive workers’ comp benefits
- Your employer cannot retaliate against you for filing a claim
- Claim denials can often be successfully appealed
- You have the right to an attorney throughout the process
The workers’ compensation system is complicated. But you now have all the information you need to protect your rights, and to know when to call an attorney who can help.
