In the US, there are different procedures to claim the workers compensation. But, in general, all the states follow similar kinds of concepts. If you are planning to go for a claim, then this article will help you in guiding with few important factors.
How to initiate the claim process?
Well, once you are met with an injury at your workplace, make sure you report the same to your employer within stipulated period. As per the general guideline, the law allows you to report within 30 to 45 days of the injury. Again this deadline varies from state to state, and you can contact your local workers’ compensation agency to know the exact period.
Next procedure in the claim process is to see the doctor of insurer’s choice. There will be a medical examination known as independent medical examination or IME. This examination covers the total case study of the injury. The doctor will enquire about your history and also the details about how you got the injury and changes in your health condition after the injury.
Once done with all the examinations the doctor will submit a detailed report to the insurer. In case the doctor’s report does not comply with the requirements, then there is a chance that your claim will be terminated. In many cases, the doctors who fail to comply with the insurer’s requirements have been dropped from the IME.
In some states, the workers’ compensation agency will deploy a doctor from a list of doctors who will conduct an impartial medical examination to the injured person. With this, the agency will get a report from an unbiased doctor, and thus the claim can be settled without any ambiguities. In case the doctor is found biased towards the injured person, then that doctor will be deleted from the list.
Once the impartial medical examination is done, the medical report submitted by the doctor needs to be reviewed and accepted by the hearing officer or workers’ compensation judge. This report will be used as a key medical evidence for the case. Important to note that the judge will accept only the impartial doctors’ report and even if the insurers’ doctor or the injured person’s doctor has disapproved the case.
After the medical report is accepted there will be a hearing process which takes place as below:
- Hearing may complete in one sitting or it may take few months
- It discusses about the sufferings faced by the injured person
- History of injury will be discussed. Whether it is an old injury or a new one or simply aggravation of the old injury. Depending upon the case employer would be held responsible
- What is the average weekly wage of the employee
- What is the extent of damage to his lifestyle because of the injury
- Discussion on the complete details of medical treatment to the injured person
With all the above mentioned detailed procedures, the claim may still get rejected due to some reasons. To understand the exact reason and avoid rejections, it is advised that you hire an injured at work attorney. Depending upon the state you reside you need to pay a nominal attorney fees.
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