Legal FAQs | Learn From the Attorneys at Pond Lehocky Giordano

Quick Answer

To file a workers’ compensation claim, promptly report your injury to your employer, ideally immediately after the incident, including the date, time, and circumstances. Gather necessary documentation, such as your employer’s workers’ compensation insurance policy number, coverage period, medical records, witness statements, and any correspondence related to the incident. File your claim within the required timeframe, noting that in some states, you have 120 days to report the injury to your employer and three years to file a claim petition if denied benefits.

Suffering a work-related injury can be overwhelming, especially when you’re dealing with medical bills, lost wages, and the stress of recovery. Workers’ compensation is designed to provide financial and medical support, but understanding how to navigate the system isn’t always straightforward.

At Pond Lehocky, we know how challenging this process can be, and we’re here to guide you. Whether you’re starting a claim or running into obstacles along the way, knowing the process is the first step toward protecting your rights and getting the help you need.

What Workers’ Comp Documents Do You Need to Gather?

When preparing to file a workers’ comp claim, you’ll need proper documentation. Start with the policy number and coverage period for your employer’s workers’ comp insurance. This information is vital for verifying that your injury occurred within the covered timeframe.

You’ll also need documentation showing the states or jurisdictions covered by the policy, ensuring your claim falls within the appropriate geographical area. Include any policy endorsements that might offer additional benefits or specific conditions applicable to your situation.

Be aware of any coverage exclusions that might impact your claim., which can include specific activities or conditions not covered by the policy. Having a clear understanding of these exclusions can help you anticipate potential challenges and address them proactively. In addition to insurance details, gather medical records related to your injury, witness statements, and any correspondence with your employer about the incident as this thorough documentation will strengthen your claim and streamline the process.

How Long Do You Have to File for Workers’ Comp?

You have 120 days from the date of your injury to file a workers’ comp claim. You should report the injury to your employer as soon as possible, ideally immediately after the incident occurs. This notification can be verbal or written but should be documented to avoid any disputes later.

Failing to report within this statute of limitations can jeopardize your eligibility for benefits. However, certain exceptions may extend this deadline, such as situations where the injury is not immediately apparent.

It’s critical to adhere to these timelines to ensure your claim is filed within the required period. Acting promptly can help secure the benefits you need for your recovery.

How Do You Know if You Have a Valid Workers’ Comp Case?

If you’re a small business owner or policyholder wondering whether to file a workers’ comp claim, there’s a straightforward guideline to follow. Any injury that requires medical attention beyond basic first-aid should be filed. This means if an employee needs to see a doctor, get a prescription, or undergo any form of treatment, you should initiate a claim.

Filing promptly helps ensure the employee receives the necessary medical care and supports your business in managing potential liability. Minor cuts or bruises that can be treated on-site might not require a claim, but anything more serious does. Even if the injury seems minor initially, complications can arise, making it crucial to have proper documentation from the start.

This approach protects both the employee’s health and your business interests. Keep in mind that timely filing and thorough documentation are key components in handling a legitimate workers’ comp case effectively. Finally, seek advice from a legal professional who can determine if you qualify for benefits and guide you through the process.

Can I Choose My Own Workers’ Comp Doctor?

When you first report a workplace injury, you are generally required to see a healthcare provider from a list provided by your employer. This list includes approved doctors and specialists who are familiar with handling workers’ compensation cases.

For the first 90 days of treatment, you must stick to one of these approved providers. This helps ensure that the medical documentation is in line with your workers’ compensation claim requirements. After these 90 days, you have the freedom to choose your own doctor to continue your treatment.

If you decide to switch, you must notify your employer and the workers’ comp insurance company about your new healthcare provider. This flexibility allows you to seek a second opinion or continue care with a doctor you trust more. Remember, whether you’re with an employer-approved provider or your own chosen doctor, keeping thorough records of your treatments and communications is crucial for your claim.

What Not to Say to Your Workers’ Comp Doctor

During your workers’ comp evaluation, it’s important to be mindful of your language. Here are some phrases to avoid:

Exaggerations about symptoms or pain: Overstating your pain can lead to doubts about your credibility. Stick to honest descriptions to ensure accurate treatment and assessment.
Negative things about your employer: Expressing hostility toward your employer can be seen as bias. Focus on your medical condition and necessary care rather than workplace issues.
Lies about how the injury happened: Providing false information about the incident can invalidate your claim. Transparency is crucial for receiving the benefits you deserve.
Speculation about future recovery: Avoid guessing about your recovery timeline. Let your physician assess your condition and provide a prognosis.
Downplaying your symptoms: Minimizing your pain or limitations can lead to insufficient medical care. Be clear and honest about your condition to receive proper treatment.
Discussing legal strategies: Conversations about legal advice or your attorney’s strategies should be kept private. Focus on your health during medical appointments.

Using accurate and objective language will help ensure your workers’ comp claim is handled appropriately.

How Long Does Workers’ Comp Last?

The length of your wage loss benefits varies based on the nature of your injury. For temporary injuries, you’ll receive 66% of your average weekly wage for up to 90 days.

After two years, the insurer may request an Impairment Rating Evaluation (IRE) to assess your level of disability. If the IRE finds that you’re more than 50% disabled, you will continue to receive total disability benefits.

If the rating is below 50%, you’ll switch to partial disability benefits, but the weekly amount will stay the same; however, you’ll be limited to receiving these benefits for an additional 500 weeks, totaling roughly 9 and a half years. This means even with a partial disability rating, you can receive wage loss benefits for over 11 years in total.

How Do You Calculate a Workers’ Comp Settlement?

Workers’ comp settlements are influenced by various factors, including the type and severity of the injury. Typically, the settlement amount is calculated based on two-thirds of your average weekly wage, subject to a maximum limit set by the state. As of January 1, 2022, the statewide average weekly wage is $1,205.00, and this figure is adjusted annually.

The year in which your injury occurred will determine the specific compensation rate applied to your case. State law mandates that the compensation rate be updated annually, with the current rate reflecting a 6.6% increase in the statewide average weekly wage for 2022.

These figures provide a general framework, but the actual settlement amount can vary depending on individual circumstances, such as the extent of medical treatment required, any permanent disability, and other related factors. Consulting with a knowledgeable attorney can provide a more accurate estimate tailored to your unique situation.

What Do I Do if My Doctor Clears Me for Work But I’m Still in Pain?

If your workers’ compensation doctor clears you for “full duty, no restriction” work despite ongoing pain, the insurance company may stop your wage loss benefits, which can be challenging if you haven’t fully recovered. Alternatively, a doctor might release you for light duty, meaning you can return to work with certain restrictions. Under this scenario, your job tasks might be modified, or you might work reduced hours, but your comp payments should continue if you’re still receiving treatment.

If you refuse to comply with the job restrictions given by your doctor, your workers’ comp payments could be stopped. Make sure to follow the recommended work restrictions to avoid jeopardizing your benefits.

If you feel that your treating doctor has exhausted their treatment options, you can request a referral to another physician for a second opinion. If your doctor agrees, your employer and its insurance provider must cover the cost of this additional medical opinion. Generally, the insurance company is not obligated to pay for a second opinion unless your authorized doctor supports the need for it.

If You Need Help Filing for Workers’ Comp or Appealing a Decision, We Can Help

The aftermath of a workplace injury can feel overwhelming, but you don’t have to go through it alone. Whether you’re filing a new claim or appealing a denial, the team at Pond Lehocky is here to support you every step of the way. We understand the complexities of workers’ compensation laws and provide personalized guidance to meet your specific needs, from gathering the necessary paperwork to staying on top of deadlines.

If your claim was denied, don’t get discouraged. Our workers’ comp lawyers are well-versed in handling appeals and can help you understand why your claim was denied while working to strengthen your case. We’ll identify any issues with your initial application, fill in the gaps, and ensure your rights are protected throughout the process.