Workers’ compensation cases can be complex, and filing can be a challenge, especially when some employers aren’t all that interested in paying workers’ comp claims.
According to the National Council on Compensation Insurance, the average cost of a workers’ comp claim is just over $41,000, but depending on the injury, many claims can be much more costly.
How Many Claims Are Filed Per Year?
According to the United States Bureau of Labor and Statistics, out of 100 full-time workers, 2.8 suffer injuries that lead to workers’ compensation claims.
The costs of those claims can be significant.
According to the National Council on Compensation Insurance, the costliest lost-time workers’ compensation claims include:
- Car crashes, which average $78,466 per claim
- Burns, which average $49,521 per claim
- Slip and fall incidents, which average $47,516 per claim, and
- Fraud, which averages $43,538 per claim
The NCCI reports that the most expensive lost-time workers’ comp cases based on the injury itself include:
- Amputation, which averages $109,926 per claim
- Fractures, crushed bones or dislocations, which average $59,253 per claim
- Miscellaneous trauma, which averages, $57,805 per claim, and
- Burns, which average $48,295 per claim. (This figure differs because the above is for costliest lost-time claims, while this is for lost time related to the nature of the injury itself.)
NCCI statistics on the most expensive claims related to parts of the body include:
- The head or central nervous system, which averages $92,439 per claim
- Injuries involving multiple body parts, which average $68,749
- Injuries involving the neck, which average $61,510
- Injuries to the hips, thighs or pelvis, which average $57,476
- Leg injuries, which average $57,476
- Arm and should injuries, which average $46,205, and
- Chest or internal organ injuries, which average $42,342 per claim. (numbers are from 2017-18.) 1
Faced with potentially debilitating injuries, it’s important not to make any mistakes while filing for your workers’ compensation insurance that could put your claim in jeopardy.
Here’s what you need to know to protect yourself and your benefits.
Legal Workers’ Comp Information You Can’t Live Without
Workers’ compensation can be terrifying territory, especially if you’re worried about paying your bills now that you are out of work. Finding a lawyer that specializes in workers’ comp cases is one of the smartest moves you can make, because you will almost always have a free initial consultation that will provide you with the information you need to proceed without making costly mistakes.
- Report your injury as soon as possible. Some states only allow a few days for you to report an on-the-job injury, and if you miss the deadline, you will have a difficult time proving that your injury happened on the job, especially if you don’t have witnesses. Failing to report your injury could result in you losing any claim for benefits.
- What should I say when I report my injury? While it is important to report your injury as soon as possible (states allow a little leeway here, but not much), you don’t want to say the wrong thing. Like getting in a car accident, you should never suggest that an incident was your fault. States allow a few days to report your injury in writing to your employer so you will have time to see an attorney and find out what to write – and what not to write – when you report your injury to your employer.
- Don’t miss your deadline to file. Deadlines to file vary from state to state, and if you miss your deadline – in Tennessee and Ohio, for example, you have just one year – you miss you chance to be compensated for your injuries through workers’ compensation.
- What doctor should I see? While you may be able to see your own doctor, you might have to see a doctor who specializes in workers’ comp cases. In other states, your employer can determine which medical provider you need to see. Find out, if you can, which doctor you are required to see so that your medical bills will be covered.
- Is my case eligible? One of the first questions you should ask an attorney after an injury is whether or not you are eligible to receive workers’ compensation benefits. If you are an independent contractor working on a job site, you are likely not covered, although that doesn’t mean you can’t file a personal injury lawsuit in that case, which is likely more lucrative. If you are eligible for workers’ comp, you are not usually eligible for filing a personal injury lawsuit, unless you were injured by a faulty piece of equipment, which would put the manufacturer at fault, or you were injured in a similar circumstance.
- What about a personal injury claim? While most of the time, workers’ comp negates a personal injury claim, in some cases, even if you are eligible for workers’ comp you may also have a personal injury claim. That’s why seeing an attorney is the smartest move you can make in the hours or days after your work accident. Some of the more common personal injury claims include:
- Car accidents
- Slip and fall accidents
- Falls from either ladders or scaffolding
- Accidents while operating heavy equipment
- Fires and workplace explosions
- Exposure to hazardous chemicals or fumes
- Exposure to hazards such as asbestos
- Accidents involving machinery or tools
- Accidents that were the result of negligence on the part of a coworker
- Accidents that occur as a result of inadequate training
- Injuries that occur because safety features are not in place
- How much compensation am I entitled to for my injury? Knowing how much you are eligible for before you attempt to settle could mean you settle for much less. An attorney can help you by revealing how much similar injuries have been worth financially so you will know what to expect when you are offered compensation.
- Should I go back to work? After filing a claim, returning to work could be a landmine of mistakes, especially if you try to return to your previous job. Not only could you put your benefits in jeopardy, but also your health and wellness. Returning to work is something you should discuss with an attorney, and if you do decide to return, only do so if you can work part-time and at a job that will be little if any stress on your injuries.
- Should I accept a lump-sum settlement? In many cases, a lump-sum payment can be a smart move, as it will allow you to catch up on any bills if you’ve fallen behind. It can also give you the opportunity to invest, which could help you significantly in the future. Your attorney will advice you as to what is best in your personal situation.
- Will filing workers’ comp impact my eligibility for Social Security Disability Benefits? If you are eligible for disability as a result of your injuries, your workers’ comp payment could reduce the amount of your monthly disability payments. There are, however, ways to prevent losing any disability payments, and the right attorney will help you make the best moves to ensure that you receive all the money that you are entitled to after an injury so you do not struggle financially for an incident that was not your fault. 2
What If My Employer Denies My Claim?
In some cases, employers and their insurance companies will attempt to save money by denying a workers’ compensation claim, and it is a possibility that yours might be among them.
If your claim is denied, you need to see an attorney as quickly as possible in order to receive benefits that you deserve.
There are several reasons for claim denials, so you should find out as much as you can as soon after your injury as possible to prevent denials that could be your fault.
The most common reasons for denial include:
- Missed deadlines. While deadlines from state to state differ, usually from one to three years from the time of the injury, if you miss filing your claim – or you fail to report your injury to your employer in writing within the time frame your state requires – your claim will likely be denied. If your claim is not filed on time, you have little recourse after it is denied.
- Employers will dispute how your injury happened. After an injury, it is important to report it to your boss immediately, even small ones, since a simple fall could turn into serious back pain at a later date. It’s also important to report the incident in writing, which is required in all states, although the time frame is different depending on which state you are making your claim. If you don’t report it immediately, it gives your employer an opening to suggest that you were not working at the time of the injury. In order to prevent a dispute, it’s important to follow the rules and gather as much evidence as possible from witnesses who saw your injury occur, so that your employer will have a more difficult time disputing your claim. That’s why you have a certain amount of time available to file a claim. It gives you time to talk to witnesses, see a doctor and collect your medical records to support your injury claim. If the workers’ compensation insurance company disagrees with your doctor’s opinion, you may need to see another physician to gather additional evidence to support your claim. Remember that insurance companies will be watching you to make sure that your injuries are real. If you aren’t genuinely injured, you will most likely get caught and your claim will be denied.
- There are certain state guidelines your claim fails to meet. There are certain state laws that restrict workers’ compensation claims for psychological conditions or long-term emotional stress at work. While a workplace shooting might qualify for a workers’ comp claim, a hostile workplace is likely something that would require another avenue in order to be compensated. Too, there is also the chance that your injuries are not considered severe enough to meet workers’ comp guidelines.
- You left your job, then filed your claim. Insurance companies usually deny claims filed after your employment with the company ends, but there are many reasons for leaving, including being laid off or fired. If you reported your injury while you were still employed – and you should have, given the short window most states allow for written reporting – there is a degree of proof suggesting that you were injured at your former place of work. Even if you were injured after you gave your two-week notice, you should have had the time to report the injury in writing. It is also possible that you were fired for reporting your workplace injury, an illegal but not completely uncommon experience. Check with a WinInjuryNetwork attorney to determine whether or not you may still qualify for workers’ comp after such a denial.
The most important thing is not to give up on your legal right to workers’ comp benefits because you were denied. After learning why your claim was denied, you may find that it was a mistake, allowing you to contact the claims adjuster to clear up the issue. In most cases, however, you will have to appeal your claim’s denial.
How Do I Appeal a Workers’ Comp Denial?
The appeals process for a workers’ compensation case denial differs from state to state, but in most cases, your first hearing – held through a state labor department or a state board of workers’ compensation – will be before a judge. You will have to present as much evidence as you’ve gathered, including witness statements and medical records to back your claim. If your initial appeal fails, there are other steps you can take, depending on the state you are in.
Need More Advice?
Our workers’ compensation attorneys will provide you with a free initial consultation, which can give you the guidance you need to determine your next best steps. Do not give up until you have exhausted your last avenue, because it will be difficult to find work after suffering an injury, and you will need all the financial help you can get.
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