The Claims Process

Can You Walk Me Through The Process Of Filing A Workers Compensation Claim?

1) NOTIFY YOUR EMPLOYER OF THE INJURY

If you are injured at work, you should bring the injury to the attention of a supervisor, to document the incident. The Workers’ Compensation Act provides that unless the employer has “actual knowledge” (such as in witnessing the accident), the employee must provide notice of the injury within 90 days. Please note that the notice need not be formal in nature – only a verbal notice is required, although to avoid any doubt, it is best to obtain an incident report from your employer regarding the injury. If your employer does not utilize incident reports and fails to acknowledge the injury, then you should either write a brief memo or send an email to your supervisor regarding the accident, to document that you reported it. Alternatively, consult an experienced Workers’ Compensation Attorney.

(2) REQUEST MEDICAL TREATMENT THROUGH YOUR EMPLOYER

In cases of emergency, no pre-authorization for treatment is needed from the employer or insurance carrier. If you are in need of emergent care, report to the local emergency room. If you are in pain, but the situation is not emergent in nature, you should ask your employer which physician you are authorized to schedule an appointment with to evaluate your injuries. Your employer may not have any idea where to refer you in the event of an injury. That is not uncommon. Your employer should place its workers’ compensation insurance carrier on notice of the injury and request treatment for you with one of their panel physicians. If the employer fails to make such a request on your behalf you may schedule an appointment with the physician of your choice and provide a history of the accident. If treatment is recommended, pick up a copy of the doctor’s office notes and bring them to a Workers’ Compensation Attorney, who could use the office note to obtain insurance authorization for the recommended treatment.

Once the workers’ compensation insurance carrier is notified of the accident you should receive a letter or phone call from a “claims adjuster,” inquiring about your injuries. Advise the adjuster of every part of your body in which you feel pain, since the adjuster will limit your treatment authorization to only those parts of your body.

You will receive a workers’ compensation claim number which you should bring with you to every medical appointment. The physicians should bill only the workers’ compensation carrier, which will cover 100% of the medical bills. You will not owe any deductible or co-payment.

(3) ATTEND EVERY APPOINTMENT WITH THE WORKERS’ COMPENSATION PHYSICIAN

While you are out of work it is important to view your medical treatment as your “job.” You must faithfully attend every appointment in order to continue receiving benefits. If possible, request a copy of the doctor’s notes before leaving each and every medical appointment. It is common for workers’ compensation physicians to instruct employees that their records will be forwarded directly to the insurance carrier. However, New Jersey law provides that patients may obtain a copy of all medical records. Do not be shy about reminding the doctor’s office that their policy is incorrect. Review the office notes immediately to make sure they are accurate and reflect a history of the work accident. If the office notes contain any errors or omissions, bring them to the doctor’s attention right away, and ask him to issue a correction.

(4) TEMPORARY DISABILITY BENEFITS

You are entitled to receive temporary disability benefits equaling up to 70% of your gross average weekly wages (before taxes) if you are out of work more than seven consecutive days. Be sure to obtain an “out of work” note from the doctor after each medical appointment. Once you are released to return to work your temporary benefits will end, even if you are not cleared to return to the same line of work. If the doctor releases you on a “light duty” basis and your employer will accommodate the medical restrictions, you should attempt to return to work. If your employer refuses to accommodate the light duty restrictions set by the workers’ compensation physician then your temporary benefits will continue. Once the doctor releases you to return to work, those benefits will end.

(5) FILE A CLAIM PETITION

After medical treatment is terminated through workers’ compensation, you will have two years to file a Claim Petition (known as a “CP”) with the New Jersey Division of Workers’ Compensation. If the CP is not filed within two years of the date of the last authorized medical appointment it will be dismissed as untimely. All Claim Petitions must now be filed electronically.

(6) ATTEND PERMANENCY EVALUATIONS

After all of the relevant medical records have been received, the insurance carrier and your attorney will schedule you for a permanent disability evaluation. The law provides that the insurance carrier may wait 6 months to schedule such an evaluation, in the event that you improve over time. Medical experts hired by both the insurance carrier and your attorney will examine you and provide an estimate of your permanent disability related to the work accident. The estimates set forth by the opposing medical experts will generally vary greatly.

(7) SETTLEMENT OF YOUR PERMANENT DISABILITY CLAIM

Your attorney will attempt to negotiate a settlement on your behalf after the reports from all of the medical experts have been received. If the parties are unable to reach an agreement, your case will be scheduled for a “pre-trial conference” with the Judge of Compensation. The Judge will review the relevant medical treatment and expert reports and provide her opinion regarding the value of your claim. If you wish to accept an offer made by the insurance carrier to settle your claim, you must appear at a Hearing in the Division of Workers’ Compensation to place the details of the settlement on the record. The settlement award must be paid within 60 days of the entry of the Order Approving Settlement.

For more information on Process Of Filing A Workers’ Comp Claim, an initial consultation with your Workers’ Compensation Attorney is your next best step. Get the information and legal answers you are seeking by calling (908) 923-0020 today.