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| Workers' Compensation Claims |
Every state mandates workers' compensation coverage for the majority of its workers. These statutes typically provide benefits to employees or their dependents for work-related injuries or deaths. In order for workers to receive these benefits, however, they must follow certain technical requirements. Although every state law is different, the claims processes under most workers' compensation statutes are similar.
Who May File a Claim?
Typical workers' compensation statutes allow only employees to file claims stemming from work-related injuries. Spouses and dependents are not allowed to file loss of consortium or loss of services claims for injuries. In the case of a work-related death, however, spouses or other dependents may generally seek death benefits and burial expenses under the workers' compensation system.
The death benefits are typically restricted to true dependents (not merely heirs). They are designed to assist the dependents in living without the employee's income. For this reason, the subsequent marriage of a spouse will negate his or her ability to receive continued benefits. Furthermore, death benefits cease with the death of the beneficiary. In some cases, however, dependent children acquire the rights of a spouse upon his or her death.
What May Be Paid Under a Claim?
Employees may typically recover medical expenses and lost wages resulting from a temporary or permanent disability. Death benefits include burial costs, usually even where a life insurance policy exists.
Claim Procedures
Most statutes require employees to notify employers of their injuries within a certain number of days after the accident. Persons acting on behalf of an employee may provide this notice to the employer. Some states require employees to notify the state industrial commission as well.
Although many statutes prescribe a certain period, i.e. 90 days, within which the notice must be given, others make general statements, i.e. the notice must be given "as soon as practicable." Sometimes, the notice provisions do not apply to death claims. Furthermore, if a worker is mentally incompetent or incapacitated because of his injuries, he or she is generally excused from the notice requirements.
Most of the time, statutory notice does not have to be given in any particular manner. Some statutes, however, require that the notice be written. These requirements are not always enforced. Sometimes, the notice requirement may be waived.
Once an employer has been notified of a work-related injury or death, it will typically notify its workers' compensation insurer. If the employer and its carrier accept liability for the injury, a notice of compensation payable will be issued to the employee.
If the employer and the insurer deny coverage on the claim, the employee may file a claim with the proper state agency. All workers' compensation statutes restrict the amount of time an employee or a dependent has to file a workers' compensation claim. Although the periods vary from state to state, they generally range from one to three years from the date of the injury. In the case of an occupational disease, the limitations periods may begin to run when the employee realizes that he or she has the disease.
Once a claim is decided, the losing party or parties have rights to appeal. Such appeals may continue all the way to the state supreme court.
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