The workers’ compensation process aims to make it relatively easy for injured employers to get the critical benefits they need. From the quick timelines to the actual rules of the procedure, the law wants you to get benefits to which you are entitled as painlessly as possible.
Unfortunately, an insurance company or an employer is involved in the process with its financial interests. They can take an approach that should be painless but instead impose a lot of pain and stress on you. How you handle the workers’ compensation claims process from beginning to end can help determine whether you can receive benefits and how quickly you may get them.
While some people receive workers’ compensation benefits quite easily, others face struggles with the filing process. If you are unsure what to include in your claim, are having trouble getting the insurance company to respond, or received a denial, you need legal help. The right workers’ compensation attorney can assist with filing your initial claim, pushing the insurance company to avoid further delays, or appeal a denial.
Consultations with a workers’ comp lawyer are free, so you have nothing to lose by learning how they can help with your situation.
Understand the Claims Process Before You Submit a Claim
Before you file, you should know as much about the claims process to present the most substantial possible claim. Deadlines and the quality of your claim matter in the process. You should consider speaking with an experienced workers’ compensation attorney at the outset of the process to give you an effective advocate when you file for workers’ compensation benefits.
You Have Limited Time to Notify Your Employer
The most critical step is to notify your employer of your injury. If you do not do this within the required time, you can lose the right to benefits entirely. In Missouri, the deadline to inform your employer of your injury is 30 days from the injury time.
Reporting your injury to the employer is not the same thing as filing a claim. You have two years from the date of the injury to file the claim, although there is little reason to wait that long. The extended deadline can be helpful when you have suffered a cumulative injury and cannot pinpoint the exact date of your injury.
Usually, the deadline is straightforward when dealing with a one-time accident. The start of the 30 days can be murkier when your injury happens over time (such as a repetitive motion injury or an illness from exposure to toxic substances). You must give your employer written notification of your injury, so they cannot come back and say that you never gave notice.
How to Notify Your Employer of Your Injury?
Your notification to your employer should include:
- the date,
- time and place of the injury,
- the nature of the injury
- the name and address of the person injured
You can write your letter to the employer or use an online form provided by the Missouri Department of Labor. You’re best off asking a worker’s compnsation lawyer to do that for you.
You Must See a Doctor Specified By Your Employer
Once you report your injury, the employer will inform you about which doctor you must see. Choosing a doctor is one area where you do not necessarily have flexibility if you want your employer to pay for this initial evaluation. If you insist on seeing your doctor, you will need to pay them out of your pocket. You should see the doctor on time because their findings will be crucial to the approval of your benefits.
Where to File Your Claim and What to Include?
You will file your claim directly through the Missouri Department of Labor. They will forward the claim to the employer and insurance company for consideration.
You should include enough information with your claim to make it possible for the insurance company to determine that you suffered a work-related injury. You have an obligation to provide enough evidence to prove your entitlement to workers’ compensation benefits. The insurance company or employer (if they are self-insured) will decide based on what you have provided.
Here is what you should include as part of the file in your workers’ compensation claim:
- Medical records - you must submit documents showing you have suffered a work-related injury. If your injuries were from an accident, it will be enough to show evidence of the injury. If you are suffering from a cumulative condition, you will need to prove that the injury developed over time to show that it is work-related.
- An accident report - if you suffered an injury in an accident, your employer has likely filed their accident report as part of their policies and procedures. The accident report can also establish that your injury was work-related.
- Medical bills - You may recover reimbursement for what you already spent on treating your injuries (if your employer did not immediately direct you to a particular physician). You should include records or prior treatment and expenditures with your claim.
- Employment records - Your benefits will depend on your income when you suffered your injuries. You should include enough records so that the insurance company can establish what you were making to determine your weekly benefits. Usually, you will need to have at least 13 weeks of income information.
You Do Not Need to Prove Fault With Your Claim
One thing that you will not need to include with your claim is evidence that shows that someone else was at fault for your injuries. Workers’ compensation is not a fault-based system. You can receive benefits, even if you are the careless one. On the flip side, you cannot sue your employer for negligence in a personal injury case if they were at fault for what happened.
You may not need to file witness statements as part of your initial claim for your claim to be approved. However, you may consider filing more evidence if there is any doubt that your benefits will be approved.
You May Need More Information about Complex Claims
One key consideration is whether your injury was work-related. In other words, it must have suffered on the job or as a result of your job. You may need statements from co-workers who saw what happened or were familiar with the conditions that led to your injury.
Then, if your claim is more complex and you anticipate more of a chance of denial, you can also include statements from:
- Vocational experts who can give their opinion that your injuries can limit specific crucial job duties
- Medical experts who can provide an independent view of your condition and what you may face as a result
You will almost always need this particular evidence if your claim received a denial and you had to file an appeal.
The Claims Process Is Not Always Straightforward
Even though there are online forms, filing a claim for workers’ compensation benefits is not necessarily easy. You should know which information to include and organize persuasively and compellingly. The situation can be more difficult when dealing with a work-related illness or a cumulative condition.
Before you file the claim, you should review your entire file to ensure you have included the best evidence clearly and concisely. You should also check your claim’s entirety to ensure it tells a consistent story from beginning to end. Your claim should be as complete as possible because missing information can cause your claim to be denied (or the insurance company will come back and ask you for more details).
You May Need Legal Help to File Your Claim
Depending on the complexity of your claim, consider hiring an attorney at the start of the process. If you have a problematic claim, you may encounter numerous setbacks and hurdles that can delay or jeopardize your benefits. An experienced workers’ compensation attorney can guide you through the process and help you present your claim in the most persuasive and compelling light.
The workers’ compensation process is stressful enough, and there are high stakes for you and your family. Even though you are not receiving your entire income, the benefits represent money you need to continue supporting yourself and your family; if there are any delays or you receive a denial, your family can be in financial jeopardy. If the insurer denies your claim, you need an experienced workers’ compensation attorney to help you appeal (as described below).
After You File, You Wait for a Response
Once you or your attorney files your workers’ compensation claim, you should not have to wait too long for a response. The law does not allow insurance companies to drag the process out indefinitely because you need the lost income and the medical payments your claim provides. Still, the insurance company will have at least 30 days to investigate your claim before they are obligated to respond. If the claim is very straightforward, you may receive an answer in less time.
The insurance company or employer will answer your claim on Form WC-22. If you do not receive a response to the claim within 30 days, the law deems the insurance company to automatically concede the facts in your claim. However, failing to respond does not mean the insurance company will automatically approve your benefits.
You Can File an Appeal When You Get a Claim Denial
After receiving a claim denial, you have the legal right to file an appeal. If the denial resulted from missing information or a misunderstanding, your attorney might attempt to speak with the insurance company to clear up the matter. When you appeal a denial, the insurance company incurs expenses, so they may not want to litigate.
You will file your appeal with the Missouri Division of Workers’ Compensation. The appeal begins an accelerated quasi-judicial process where you will have the right to your day in court. Before you reach that point, you may choose to have your case mediated or settle with the insurance company.
If you cannot get a resolution, an administrative law judge will determine whether you have the right to benefits. If you do not win at the administrative phase of your case, you can take your case to state court in Missouri.
You Need an Experienced Attorney When You Are Filing an Appeal
Insurance companies have infrastructure and apparatus often dedicated to making your life as difficult as possible.
For numerous reasons, you will need an experienced compensation attorney to help with your Missouri workers’ compensation claim.
- You need to process and handle a lot of information in a short time when you must deal with physical injuries and need medical treatment.
- You may not know what medical evidence to produce or how to make the most compelling case possible.
- You may have suffered an injury presumptively tied to your job, and you need to present the evidence to show that you deserve compensation.
- Your employer can make your life difficult and even take retaliatory steps against you for filing a claim that will raise their insurance rates (it is illegal under state law for an employer to retaliate against an employee who has filed a workers’ compensation claim).
- You may have suffered a permanent disability and need to negotiate a settlement with the insurance company (or you may disagree with the disability rating you were assigned).
- You have a preexisting condition that the insurance company may try to blame for your inability to work.
It does not cost you anything to hire a St. Louis personal injury law firm upfront. Your attorney only receives payment if you win your case. If, for some reason, you are not successful, you will not need to pay your attorney for their time.
The attorney generally receives a percentage of your financial recovery, although this percentage is usually lower than the one they will receive if they handled a personal injury lawsuit. You have every incentive to hire an attorney, especially when your right to benefits hangs in the balance.