Do You Qualify for Workers’ Compensation Benefits?

Do You Qualify for Workers’ Compensation Benefits?

Workers’ comp claims processing can be complex and involve many steps including medical record retrieval. Find out whether you qualify for these benefits.

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Many people are injured while on the job or develop work-related illnesses/conditions that may be compensable. Sometimes, obtaining workers’ compensation can turn out to be a complex process which requires various steps including medical record retrieval as an initial process.

Typically, injured or ill employees are compensated for their medical expenses, lost income, and ongoing treatment costs. To qualify, the employee must have been injured while at work or while he/she was performing the duties assigned to them. The gradual onset of diseases that are acquired, worsened, or quickened due to employment ( with the job being the main contributing factor) may be compensated.

That said, who qualifies for workers’ compensation or what are the factors that are considered when determining eligibility?  All workers including temporary or seasonal workers are covered by the workers’ compensation program in most U.S. states. It does not cover independent contractors.

Whether a temporary worker will be covered by the program would depend on whether he/she is treated as an independent contractor or as an employee.  Workers who hurt themselves while fighting or when intoxicated may not be considered eligible. If a worker is injured as a result of his/her misconduct, they will be disqualified from eligibility to file a claim – examples include injuries resulting from fights, from using illegal or non-prescription drugs, and from self-inflicted pain.  An employee could lose his/her right to receive workers’ compensation benefits if they don’t meet the deadlines in their individual states for reporting the injury to their employer and filing a claim.  Typically, the deadlines for filing claims are in the range of 1 – 3 years after the injury though some states allow more time. Wisconsin, for instance, allows 6 years from the date of injury, but there is no time limit for serious injuries like permanent brain damage.  If the employer provides some medical benefits before the employee filed a claim, the time limit may not start until those benefits stop.  Some states have included a few limited exceptions to the time limits for filing a claim. This includes when the worker was unable to file a claim immediately because the injury resulted in a coma, the injury was severe and required www.mosmedicalrecordreview.com

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immediate and prolonged treatment or surgery, or the worker had to remain in quarantine because of the injury that could be contagious.

U.S. government employees must file a claim within 3 years after the injury.

Compensation may be allowed if the worker had given written notice of the injury within 30 days or the immediate supervisor knew about it.  Certain categories of workers may be exempt from benefits in some states under the state law. However, other states may offer coverage as well. These groups of workers include domestic workers, agricultural and farm workers, leased or loaned workers, casual or seasonal workers, and undocumented workers such as immigrants who don’t have legal status to work in America.  An examination may be done by the employing company’s doctor if the employer’s insurance carrier requests for it. This evaluation is done to prove the worker’s claim that the injury is work related.  If an employer does not carry workers’ compensation, it may be possible for the worker to sue for access to benefits. Employers can be sued for negligence on their part as employers and fault for the injuries sustained by the employee.

Workers’ compensation program is designed to provide the required financial support to employees who are injured or become ill due to their jobs. If any dispute arises with the employer or insurer, workers can consider consulting with a workers’ compensation attorney for the right advice. With the support of medical review companies, attorneys will understand the medical aspects and determine whether you have a genuine claim. They will help you gather all necessary documentation, and submit your claim properly.

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