When you are injured in a workplace accident, it is important that you follow the correct procedure for filing for workers’ compensation. Complying with the state laws is critical to remaining eligible to receive compensation for your losses, which could be fairly substantial. Whether you need to only receive partial wage replacement for the period of time you spend working a less demanding job as you recover from your injury or you need tens of thousands of dollars’ worth of medical treatment compensation, you need to follow the steps outlined below to avoid losing your right to receive the compensation you seek.
1. You are Involved in a Workplace Accident
If your accident is serious, call 911 right away to receive emergency medical care. If not, seek first aid immediately and medical attention for your injury as soon as you can, which is often once you notify your employer of your accident and receive a referral to one of the doctors whose work is covered by your employer’s workers’ compensation policy.
2. Notify your Supervisor of your Accident and Injury
After receiving medical attention for your injury, notify your supervisor of your injury as soon as you can. You have 30 days from the date of your accident to notify your supervisor in writing of your injury. Your employer must provide you with a list of at least three nearby doctors who can provide you with the medical care you need. Once you choose a physician with whom to work, he or she is your authorized treating physician throughout your recovery from your workplace accident. This is the physician who will later make the determination that you have reached maximum medical improvement (MMI) or, if you suffer from a permanent injury, determine your level of impairment.
3. Your Employer Files your Workers’ Compensation Claim
Once you notify your supervisor of your injury, your employer must file the workers’ compensation claim with the Tennessee Department of Labor and Workforce Development’s Workers’ Compensation Division within one working day. This claim is known as the Tennessee Employers’ First Report of Work Injury or Illness form. It then files the claim with its workers’ compensation provider as well. Your employer also files your claim with the Occupational Safety and Health Administration (OSHA).
4. The Workers’ Compensation Provider will Confirm that it Received your Claim
This happens within two days of the provider receiving your claim. It is not an acceptance or denial of your claim, but simply an acknowledgment that it has been received.
5. You Receive an Acceptance or Denial of your Claim
Within 15 days of receiving your claim, your employer’s workers’ compensation provider will notify you to communicate whether the claim was accepted or denied.
If the claim is accepted, you receive the compensation you need to cover your medical bills and lost wages. This occurs when the attending treatment physician files a report stating that you have reached maximum medical improvement with the workers’ compensation provider. Your doctor assesses your improvement and your impairment rating, if applicable, so the workers’ compensation provider can determine a settlement amount. Sometimes, it is possible to receive your workers’ compensation coverage in one lump sum rather than spread over the course of weeks or months as you recover.
If your claim is denied, you do not receive anything unless you can reach a settlement with the workers’ compensation provider. This could require you to take any, or possibly a few, of the following actions:
- Revise your claim to comply with the correct procedure;
- Provide more substantial proof of your accident and resulting injury; or
- Have your claim brought to the Court of Workers’ Compensation for a review.
If your claim is denied, work with an experienced workers’ compensation attorney to determine why it was denied and how you can correct this issue before moving forward with your claim. When you are recovering from an injury, do not waste time submitting your claim again and again – determine what you need to do to get the money you are seeking and work with an attorney to make it happen.
The Importance of a Benefit Review Conference
Within one year of your accident, file a Request for Benefit Review Conference form with the Tennessee Department of Labor. This form preserves your right to a Benefit Review Conference, which is a meeting between you, your lawyer, and a representative of the Department of Labor to determine an appropriate settlement amount for your claim. This is the easiest way to resolve a dispute if one should occur after your workers’ compensation provider receives your claim. A workers’ compensation attorney can prepare and file this form on your behalf.
Once you have reached MMI, you can file your Certificate of Readiness to schedule your Benefit Review Conference. This conference is designed to allow you to receive the compensation you need without having to go to court. But if you cannot resolve your workers’ compensation dispute during your Benefit Review Conference, you might have to file a lawsuit to have your claim resolved in court.
What if I Have to File a Workers’ Compensation Lawsuit?
If you have to file a workers’ compensation lawsuit, your claim’s resolution will be decided by a judge. Remember, you do not have to prove that your employer was at fault in any way with a workers’ compensation lawsuit. Workers’ compensation claims are no fault claims, which means that negligence on either your part or that of your employer does not play a role in determining whether you can receive compensation for your losses sustained in a workplace accident. What does determine this is whether your claim qualifies as a workers’ compensation claim. This comes down to two elements:
- Did your injury occur while you were at work or performing work-related duties? You cannot file a workers’ compensation claim for an injury sustained outside of work, even if that injury was sustained while going to or coming home from your job; and
- Did your workplace injury lead to quantifiable medical treatment expenses or lost wages?
You and your attorney need to prove that both of these elements are present in your claim to qualify you for a workers’ compensation settlement.
When you appeal your workers’ compensation decision, it goes through a legal hearing. Although this is not a court of law, it adheres to the state laws governing workers’ compensation claims and their resolution. If your claim is denied at this stage, you may continue to pursue it through the state court system.
When Do Workers’ Compensation Benefits End?
This depends on the type of benefits you receive. Generally, benefits end once an individual makes a full recovery is cleared to return to work without restrictions. If the recipient violates the terms of his or her settlement in any way, such as refusing to return to light duty work despite his or her doctor clearing him or her for this type of work, he or she can lose these benefits. Otherwise, accepting or rejecting a job offer for a position paying the same amount or more than the individual received prior to his or her injury means the end of his or her workers’ compensation coverage.
When an individual is determined to be permanently disabled, whether partially or totally, these benefits can continue until he or she reaches retirement age and becomes eligible for Social Security retirement benefits.