Workers’ compensation is a critical resource for anyone injured on the job. It provides an injured worker with an avenue to cover their medical bills. However, the process of filing a claim can be a little tricky.
Understanding how to file a workers’ comp claim requires knowing the steps and what can impact the process along the way.
Steps To File a Workers’ Compensation Claim
The process of filing a workers’ compensation claim isn’t obvious, but it is relatively easy to follow along with.
Seek Medical Treatment
Seeking medical treatment should be one of your first steps if you sustain an injury at work. For non-emergency medical care, you will need to visit an approved healthcare professional. Without pre-authorization, you will not be eligible to have your medical costs covered.
Generally, for non-emergency situations, you can report your injury to your employer first. They can tell you which doctors and healthcare facilities you can use.
For emergency care, you can proceed immediately to the emergency room. However, you still need to let your employer know as soon as possible.
Be sure to follow any directions the doctor gives you. You should also keep copies of any medical records.
Report the Injury/Illness
Along with seeking appropriate medical care, one of the first things you will want to do when filing a workers’ compensation claim is report the injury or illness to your employer. Reporting it right from the very start will help the process go smoother.
Depending on the specific laws governing your issue, you may need to make your report within 48 hours. If you wait longer, you may not have a case.
Give your employer a written notice of your injury and treatment. Keep a copy of this notice for your records and include any responses your employer gives. You should also note the date and time you made the report and who you notified.
Completing the Claim Form
In many cases, your employer will file the actual workers’ compensation claim for you. They’ll file this report with the New Jersey Division of Workers’ Compensation. This will happen after you have notified them about all the details relating to your injury.
Either your employer or their insurance carrier must file a First Report of Injury within 21 days of when you report your injury or illness.
However, you should follow up with your employer to make sure they do so. If they have not promptly filed a report or are refusing to do so, you may want to find a New Jersey workers’ compensation attorney.
Understanding Eligibility for Workers’ Compensation
A key part of knowing how to file a workers’ comp claim is understanding eligibility, because only specific incidents are eligible for workers’ compensation.
However, not all workers’ compensation rules are the same. They vary from state to state. So, make sure you only look at workers’ compensation rules in New Jersey.
Coverage Criteria
All employers in New Jersey must have workers’ compensation coverage, which covers all of their employees. The only exclusion is for employers who qualify for coverage through federal programs instead.
Types of Injuries Covered
Workers’ compensation aims to cover injuries or illnesses that occur at work. These take many shapes and forms.
Many people think of work-related injuries when they think of workers’ compensation. If you’re hurt while doing your job, it would fall under this category. It could be an injury from a one-time accident or a condition that built up over time.
Illnesses are eligible as well. Specifically, the illness needs to be an occupational disease that you contract at work. It can’t just be any sickness you catch while on the job.
Exceptions and Limitations
- Independent contractors are not typically covered by workers’ compensation.
- Injuries or illnesses that do not stem from work are not covered.
Documentation Required for Filing a Claim
Filing a claim requires some documentation. Good documentation will help give the claim a better chance of success.
Medical Records
You should include any and all relevant medical records with your claim, including any documentation from healthcare visits.
Incident Reports
Some workplace accidents lead to an incident report. The company put together this report to explain exactly what happened.
Witness Statements
Some workplace accidents occur in front of witnesses. Gathering statements from these people can help. The claim should include these statements.
Submission Process for Filing a Claim
Usually, your employer handles the process of submitting a claim. However, if they do not start the process or fail to do so promptly, you can file a claim yourself.
Deadlines and Timeframes
The deadline to file a workers’ compensation claim is within two years of either the date the injury took place or the last payment of compensation — whichever is later.
However, this two-year countdown keeps running even after the process starts. So, waiting until the deadline may lead to the deadline passing before your hearing even takes place.
Methods of Submission
The easiest way to submit a claim is to visit the New Jersey Department of Labor and Workforce Development’s website. You can find the relevant information in the Forms and Publications section of the site. There, you can download the files for a formal Claim Petition or an Application for an Informal Hearing.
Find the form you are looking for, and print it out. Then, you can fill it out and return it to the office at the address listed on the form.
Contacting the Workers’ Compensation Board
You can contact the Workers’ Compensation Board at any point in this process for help figuring out how to file a workers’ comp claim. Their phone number is (609) 292-2515.
Review and Follow-Up on the Claim
After either you or your employer file the claim, you can check up on it. Following up is a great way to ensure the process is going smoothly.
Tracking the Progress
Your attorney can check the process of your workers’ compensation claim via New Jersey’s Department of Labor and Workforce Development website.
Responding to Requests for Additional Information
If the insurer sends you a request for additional information, this doesn’t necessarily mean you did something wrong. Often, it means that a piece of information was simply not included in the original claim.
These requests contain instructions for how you should respond. If you are still confused, contact your attorney, and they can help you work through the problem.
Appealing a Denied Claim
If the insurance carrier denies your claim, it isn’t necessarily the end of the road. You can appeal the issue through the Appellate Division of the New Jersey Superior Court.
Again, this is something you will likely need the help of an attorney for. They can elevate the situation for you.
How Long Will It Take To Secure Benefits?
The exact length of time it takes to secure workers’ compensation benefits varies. On average, you can expect a two-week wait, assuming your employer submits everything promptly. Failing to notify your employer immediately will lead to a delay.
In some cases, your employer or their insurance can cause a delay. If this delay is unreasonable, you may be able to take action against it. Delays lasting 30 days or longer are unreasonable.
When dealing with unreasonable delays, you may be eligible for an additional 25% of the amount due to you. In addition, you may secure compensation for reasonable legal fees that you incur from the delay.
Tips for a Successful Workers’ Compensation Claim
Even if you are eligible for workers’ compensation, it doesn’t mean you will secure it. Many people regularly make a few common mistakes that ultimately lead to rejection.
Luckily, there are a few tips that can help you avoid these common mistakes.
Reporting Injuries Promptly
You should make your injury report as quickly as possible. Doing so prevents you from missing any important deadlines. It also helps prove that your report is accurate and not something that you made up at a later date.
Keeping Detailed Records
Throughout the process, keep a record of everything you can. Include as many details as possible. These may prove invaluable at a later point.
Be sure to list who you speak to about your claim and when. You should also keep any documents related to your claim.
When you can, put details in writing. Written records are easier to keep track of and prove than spoken communications.
Follow Medical Advice
It is critical that you follow your doctor’s orders after you meet with them. If you fail to do so, it could impact the coverage relating to your care going forward.
Filing a Workers’ Compensation Claim
Understanding how to file a workers’ comp claim can be tricky, but it’s critical if you sustain an injury on the job. When you notify your employer about your injury or illness, they should file your workers’ compensation claim for you. If they don’t do this, you will need to start the process yourself.
An experienced workers’ compensation attorney can help. Call Sadaka Law in Englewood, NJ, at (800) 810-3457 to request a free consultation.
