What Roles Are There in a Workers’ Compensation Claim?

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Workers Compensation Claim

In the event of an accident in the workplace, there are certain steps that must be completed in order to file a workers’ compensation claim. You, your employer, and the insurance company all have your own separate roles in the claim process. If your employer or the insurance company is not cooperating, hiring a workers’ comp lawyer in Florida may be your only option for compensation.

Your Duty as The Injured Employee in a Workers’ Compensation Claim

As the injured employee it is your duty first and foremost to inform your employer that you have been injured on the job. This must be done within 30 days of incurring the injury or a doctor informing you that the injury you sustained was work-related. Failure to do this could end up in a denial of benefits.

Make sure that when you are informing your employer of the injury that you find out who the workers’ compensation approved doctor is. Most insurances require that you see a specific doctor in an injury claim. If for some reason your employer is not available at the time of the accident, you need to go to the nearest emergency room and inform them as soon as they are available.

Your employer is obligated to inform the insurance company of the injury within 7 days of it happening. Once the insurance company has been notified one of their claim adjusters will contact you to explain your rights and obligations to you. If they call and you do not answer, make sure that you return their call. At this point, due diligence is going to be extremely important.

Once you receive the information packet from them you need to make sure that all of the forms enclosed are filled out and returned promptly. It is going to include a copy of the initial accident report that you must verify as being correct. A fraud statement that you must sign and return stating that you understand and agree to the terms, failing to do this in a timely manner may cause a delay in benefits.

The medical record release form should be filled out along with the mileage reimbursement form. When you see the doctor make sure to find out what you can and cannot do and if work will even be a possibility. You should also be making sure that your employer is informed every step of the way.

Workers’ compensation benefits will begin paying a portion of the wages beginning on day 8, once you have been off of work for 7 consecutive days. If you are required to be off work at least 21 days, that is when the initial 7 day period will be compensated.

The Duty of the Employer of the Injured Employee

As the employer of an injured employee, it is their duty to report the accident and/or injuries to the insurance company as soon as possible. This must be done within 7 days of the incident. It is also the duty of the employer to remain in contact with the employee during the time they are seeing the workers’ compensation doctor. They must adhere to any restrictions that the doctor may place on the employee.

The employer must maintain the posters and information required by law posted clearly and in view for their employees to see so that they are aware of their rights. If the employer does not have these or needs replacement, they should contact their insurance agency for replacements.

There is a legal requirement of all workplace accident records to remain on-site for 2.5 years. This includes the accident forms as well as all the information that insurance requires for the claim. The employer must submit the wages for the employee to the insurance company within 14 days of reporting the injury. An employer can receive penalties for filing claims and paperwork late, so cooperation is necessary to expedite the claim.

The Duty of The Insurance Company

It is the duty of the insurance company to review all of the submitted information, including the initial injury and sending out the appropriate paperwork, in a timely fashion. It is the responsibility of the insurance company to review the claim and if they deny it, the employee must be notified within 14 days of the initial injury.

If you feel that your employer or their insurance company is not doing their due diligence or is not giving you a fair claim, you need to acquire legal counsel as soon as possible. For workers’ compensation cases, the best thing you can do is acquire an experienced law firm that handles workers’ comp claims in Florida at the beginning of your claim process.

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