Injuries, Illness and Insurance: Demystifying Worker’s Compensation

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For most employees, worker’s compensation is confusing. Here is some information that will hopefully make it easier for you to understand, should you ever need it.

What Is It?

If you’re injured on the job, your employer must cover you for time lost. You can file a claim for worker’s compensation benefits as soon as you become injured on the job or develop an illness that is related to your work. In fact, if you don’t do this, you could be putting yourself at serious risk of not being able to claim benefits at all.

Things get more complicated when you have an illness or injury that developed over time, because now you have to be able to show that the illness was caused by your working on the job.

The clock starts ticking when you take time off from work because of your injury.

Fortunately, initiating a claim is simple. You just have to notify your employer of your injury or illness (it must be work-related). In most states, you also have to file a formal workers’ compensation claim.

Your employer may work with a company like Review Med to review your case, or you may work with companies like this to help you get back to work quickly.

The Filing Process

To file, you must meet the requirements. First, you have to file a claim within the time limits set by FECA. You must also be an employee under the meaning of FECA and have been injured on the job or doing work that is part of your normal job duties.

The injury or accident must be reviewed by a medical professional, and you must be diagnosed with an injury or illness connected with the event. You must also show medical evidence that shows the diagnosed condition was causally related to the event or injury. In other words, you have to have been injured on the job, and you must be able to prove that your injury was caused because of the work you were doing.

To file a claim, you must normally go through your state’s workers’ compensation office.

Am I Covered?

Probably. All civilian employees of the U.S. are covered. Unless you are paid from non-appropriated funds, or are military, or in the peace corps or non-federal law enforcement, you will be covered under the normal worker’s comp laws. If you are not covered under the worker’s compensation laws, you are covered under special federal laws.

What Happens When You’re Injured?

You should report the injury to your supervisor right away.

Complete a form CA-1 or CA-2 and give it to your supervisor. If it’s a traumatic injury, get authorization using form CA-16 from your supervisor for treatment by a physician. You can choose your doctor. You must also give your employer evidence of a disability within 10 days of claiming continuation pay.

Your Responsibilities and Time Limit

You must file a claim within 3 years of the date of the injury. If you don’t, compensation might still be paid if a written notice of the injury was given within 30 days or the employer had knowledge of the injury within 30 days after it occurred.

Do You Have To Fill Out The Form Or Can Someone Else Do It?

Generally, you must fill out the form for your injury or illness, but someone else can if you cannot. Another person, like your supervisor, may act on your behalf. The person making the report needs to complete and sign the form and then submit it to your supervisor.

Getting Names Of Witnesses

When you’re injured, it may be difficult to know what you should be doing and in what order. Make sure you get names of witnesses. In a close case, you might need them to prove that you were injured.

Explaining How You Were Injured

Insurance companies tend to deny cases when you’re unable to explain, in detail, how you were injured or made sick. If your initial medical records do not adequately describe the accident or the injury, then don’t expect to be paid.

Fill Out The Accident Forms Accurately

While your employer can fill out the accident form for you, most likely he will ask you to do it. You should fill out the report accurately and put in as much of the detail as you can remember. Do not embellish your story.

It might be tempting, or you might think that certain wording will help you. But, if you make a materially false statement, it could affect your ability to get workers’ compensation payments.

If you feel too ill or medicated to fill out the reports when your employer wants you to, do not do it. Wait until you are rested or well enough to fill out the forms. Keep in mind that you need to do this within 3 years of the accident or incident taking place, but you should do it within 30 days.

Lydia Price is a worker’s compensation claims specialist who has worked in this field for 8 years. She realizes that this is a complicated area for the individual to delve into, particularly at a difficult time in their life, and hopes to shed some light on the subject through her writing.