First steps in the claim process

Injured workers should report their injury to their employer and seek medical treatment as soon as possible. A worker has 90 days to report their injury to the employer and up to a year to file a claim after that.

If the claim is based on work exposure, rather than a specific injury, the worker should file within a year of when they are diagnosed and learn that the condition may be work related. There are exceptions to this rule which should be discussed with an attorney.

At the outset of the claim, the worker can choose their doctor but many doctors refuse to get involved in workers’ compensation claims. Contact an attorney if you need a recommendation for a doctor in your area.

It is very important that you develop good relationships with all of your treating doctors. You will need to choose one doctor to serve as your “attending physician”. The attending physician is responsible for directing care, making referrals, authorizing time off work, and deciding when you have reached maximum improvement.

Generally we recommend that you choose an M.D. or a D.O. because there are limits on how long a chiropractor or nurse practitioner can serve as the attending physician.

If the doctor restricts your work activities, you need to get the restrictions in writing and provide a copy to your employer to see if they can accommodate your restrictions. Always keep a copy for yourself.

The workers’ compensation insurer is required to accept or deny your claim in writing within 60 days. Unless they deny the claim within the first 14 days, they are generally required to start paying lost wages. If the claim is later denied, these benefits will stop until the denial is overturned on appeal.

Many times the insurer will accept some, but not all, of the conditions the doctor has diagnosed. This is important because the insurer is only required to provide benefits for the specific condition(s) they have accepted. In these situations, it is very important to contact an attorney. Generally, the attorney will request that the insurer accept additional conditions and they will get another 60 days to issue a written decision on that request.

Even if the insurer pays benefits on a condition, this does not necessarily mean that they have accepted or are required to accept the claim or condition. You have to make a written request.

If a claim or condition is denied, you should contact an attorney immediately to appeal the insurers decision by requesting a hearing. After you file your appeal, it takes at least 4 months to get a hearing and a decision from the judge and often takes much longer to deal with subsequent appeals.