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What Is Involved in the Workers' Compensation Process?

Workers that are injured while at work may be entitled to workers' compensation disability benefits.
Article Details
  • Written By: Felicia Dye
  • Edited By: Melissa Wiley
  • Last Modified Date: 05 July 2014
  • Copyright Protected:
    2003-2014
    Conjecture Corporation
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Workers’ compensation refers to a state-mandated insurance program designed to provide medical care and income for individuals who are hurt during the course of work. When a person is hurt on the job, he is generally allowed to seek immediate medical care at no cost. The next steps in the workers’ compensation process are to file an incident report with the employer and a claim with the appropriate insurance company. If that claim is successful, the individual may have access to several types of benefits. If the claim is denied, the injured employee can usually appeal.

The worker’s compensation process often starts when there is an incident in an occupational setting that results in an employee being harmed. The law generally requires the injured individual to immediately notify an authority. The individual should then be allowed to seek medical attention. In many cases, he will be provided with a list of health care providers to choose from.

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When seeking medical attention, the individual should inform the doctor that she has been hurt at work. The doctor should make a note of this in the medical record. Whether or not the individual returns to work is a decision that is made by the doctor, and both the employer and employee should respect these orders. The next step in the workers’ compensation process is usually filling out some type of incident report, which should be kept on file by the employer. When the injured individual files her workers’ compensation claim, she should submit both this document and her medical records.

The injured employee should continue to receive medical care, covered by the workers’ compensation insurance, for as long as necessary. He must usually remain within a network of health care professionals. In the instance that a specialist is required and no one with those qualifications is in the network, he will likely be limited to the specialist that he is referred to by an in-network doctor.

If the individual is out of work more than a certain number of days, which varies from state to state, she can generally apply for compensation benefits. The amount will be calculated based on a formula that assesses her wages prior to the injury. She may also receive this type of compensation if she is permitted to return to work but is confined to a position with less earning potential due to her injury. The workers’ compensation process usually limits the number of payments that a person can receive in these circumstances.

In instances where the individual may never return to work, he may receive disability benefits. These are also calculated using his past income. A major difference, however, is that these may continue indefinitely.

There are several other types of benefits that may be accessible to an injured employee or his family, including death benefits and funds for training in a new profession. All benefits, however, are subject to approval of an individual’s claim. If a person’s claim is denied, the workers’ compensation process usually affords opportunity for an appeal. The individual may also utilize the assistance of an attorney.

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