How to File a Workers' Compensation Claim

Step #1: The first step is to get medical care. If the injury happens at work, your employer may require you to see a company doctor before going to your regular doctor. You may be able to avoid seeing a company doctor if you make a written request in advance to see your own doctor in the event you are injured on the job.

Step #2: Second, you must notify your employer. States may set a time limit on how soon after the injury you have to tell your employer that you were injured. You may not have to give formal notice if your employer was present when you were injured or otherwise knows about the injury. The notice should include your name, address, occupation, and employer's name and address; when the injury or illness occurred; and a description of the injury or illness.

Step #3: Third, you must file a claim with the workers' compensation agency. Don't waste any time. You have a limited amount of time to file, and the time limits vary from state to state (usually one or two years from the date of the injury). Your employer should provide you with the necessary forms to file a claim. Your employer will generally file the claim with the insurance company.

If your employer doesn't dispute your benefits, then you're all set. The insurance company will start paying benefits. The employer may require you to take a medical exam. It is the doctor's duty to determine whether your injury is work related. Your employer has to pay for the exam as well as for time missed from work.

Disputed claims
If there is a dispute, your case will have to go to a hearing. Usually a state's workers' compensation board hears disputes over benefits. The board often tries to get the two parties to settle before moving on to a formal hearing. If there is no settlement, the hearing is held in front of an administrative law judge, with both sides presenting their cases. Whether or not you need an attorney depends on how complicated your case is.

If the judge rules against you, you can appeal to have the full board review your case. Usually the board reviews the record; it doesn't allow you to present any additional evidence. Finally, if the board rules against you, you can appeal to a court. Some courts can only review the law; other courts will do a limited factual review.

If you file a fraudulent or untruthful claim, you may be subject to penalties.