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At any given time, day or night, there are millions of people working, doing thousands of different jobs and tasks. Unfortunately, accidents happen and workers get hurt. It happens quite often, too – millions of times each year. On the upside, every state requires most employers to provide workers’ compensation coverage their workers.
Typically, employees or their dependents are entitled to benefits 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 very much alike.
Who May File a Claim?
Usually, only employees injured on the job may file claims for benefits. So, your spouse or dependents can’t file a claim for loss of consortium (loss of your “companionship”), for example, because of your work-related injury.
Death Benefits are an Exception
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. These benefits are designed to help fill the gap in the family budget left by the loss of your income. So, as a general rule, these benefits typically end when:
- Your spouse remarries or dies
- Your dependents die
What May Be Paid Under a Claim?
There’s a broad range of workers’ compensation benefits, but generally injured employees are entitled to:
- Payment of their medical expenses
- Full or partial replacement of lost wages caused by their inability to work
- Death benefits
Claim Procedures: Getting Your Benefits
Tell Someone About the Injury
Most laws require employees to notify employers of their injuries within a certain number of days after the accident. Some laws require employees to notify their state’s workers’ compensation agency, too. Talk to your employer or check with your state agency for more details.
When to Give Notice of an Injury
Many state laws give you a certain amount of time, like 90 days, to notify your employer and/or state agency about your injury. In other states, you may have to give notice “as soon as practicable.” Failing to give notice within the time frame given may bar you from getting benefits. To be safe, give notice as soon as you know you’ve suffered a work-related injury.
How To Give Notice
Most of the time, you don’t have to follow any special form when notifying your employer or state agency about your injury. Some statutes, however, require that the notice be written. Also, your employer or agency may have a form for you to complete.
As a practical matter, it’s always a good idea to give written notice and keep a copy of it for your records.
It’s the Employer’s Move
Once an employer knows about a work-related injury or death, it will typically notify its workers’ compensation insurer. Two things may happen next:
1. Claim Allowed. The employer and the insurer may agree to pay benefits, and a notice of compensation payable will be sent to you.
2. Claim Denied. The employer and the insurer may deny coverage for the injury. This gives you the right to file a claim with your state’s workers’ compensation agency. Every state limits the amount of time you or a dependent have to file a claim. It may 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 you realize you have such a disease.
Appeals are Possible
Once a claim is decided, anyone unhappy with the result may file appeals in the state court system. For instance, you may appeal if you think you were entitled to more benefits or if you were denied benefits altogether. The employer or insurer may appeal if they think you weren’t entitled to benefits or paid too much.
Appeals in workers’ compensation cases may go all the way to the state supreme court.
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