Federal employees. Federal employees are not covered by state workers’ compensation systems. Instead, they are covered by the Federal Employees’ Compensation Act, which outlines its own method of processing and adjudicating workers’ compensation claims that is unique to federal workers. [1] X Trustworthy Source US Department of Labor Federal department responsible for promoting the wellbeing of workers Go to source Maritime workers (e. g. , longshore workers) who are injured or killed on the job may be protected by the Longshore and Harbor Workers’ Compensation Act as opposed to state workers’ compensation laws. Native American organizations are typically not considered “employers” for workers’ compensation claims.
For example, if a delivery driver strains his back while picking up a heavy box during a delivery, then the injury arose out of employment because picking up heavy boxes was a contributing cause of the injury. However, if a delivery driver strains her back while moving her child into a dorm room, then that injury falls outside the scope of employment. Workers’ compensation rules will vary by state. Some states preclude workers from claiming work-related stress injuries. Some states, however, permit recovery for psychiatric stress injuries. You will need to talk to an attorney to find out precisely what rules apply to your situation.
medical care for injury or illness temporary disability benefits to replace wages while you recover permanent disability benefits intended to compensate individuals with a reduced working capacity job displacement benefits to pay for job training death or burial benefits
Some states provide online calculators you can use to get a rough estimate of what your benefits might be. Colorado, for example, has a calculator available here. Some states will reduce the benefit amount if the disability can be attributed to other, non-work factors that contributed to the worker’s permanent disability.
You have a limited amount of time to inform your employer of the injury. If you miss the deadline, then you may lose your eligibility. The amount of time differs by state. Oklahoma workers, for example, have 30 days to report the injury. [5] X Research source New Hampshire workers, by contrast, have 2 years. [6] X Research source To be safe, you should report as soon as possible—preferably within a week, unless you know for certain what your state deadline is. If you are the member of a union, then you should tell your union representative of the injury as soon as possible. In many states, employers and unions have created labor-management “carve-outs” which are alternative systems for adjudicating workers’ compensation claims and processing benefits. [7] X Research source Cal. Lab. Code §§ 3201. 5, 3201. 7; Cal. Code Reg. §§ 10200-10202. 1
Your employer may provide workers’ compensation medical care through a workers’ compensation health network. If so, you must visit a doctor in the network. If so, ask your employer for a list of providers. Some states have a list of doctors who are prohibited from treating people seeking workers’ compensation benefits. Your employer should also have a list; if not, check with your state’s Department of Labor.
Be sure to attend all appointments and reschedule ones that you can’t make. Also take prescribed medicines and attend physical therapy.
If you have been denied benefits, then you will receive a denial letter. If you are awarded benefits, then the letter should specify what next steps you must follow to set up payments.
Workers’ compensation claims are denied for a variety of reason. The most common are: you did not report the injury within the required time, the injury is not severe enough, or the injury was not sustained on the job. [9] X Research source Pay particular attention to deadlines. You often will be given only a month to bring the appeal, if not less. If you want to appeal, you should begin immediately.
Bring a copy of your denial letter as well as all of your medical information to the lawyer, who will need copies of this information for your appeal. And promptly gather any other information your attorney needs. Delays will only delay the appeal process. Private attorneys will work on a contingency basis. This means they are paid only if they win your case. Generally, the attorney will take around 20% of your benefit amount. [11] X Research source The amount is often capped by state law. [12] X Research source Under a contingency arrangement, you will still have to pay for costs. Typical costs include filing fees, expert witness fees, and money spent on photocopying and mailing. Try to get an estimate of these costs upfront.
Federal workers may appeal in three ways: by requesting a hearing, by appealing to the Appeals Board, or by applying for reconsideration. Each federal appeal requires different things from the employee. In a hearing, you simply request that the hearing representative review the claim. The hearing representative may agree to give you benefits or confirm the initial decision. When appealing to the Employee’s Compensation Appeals Board, you may not provide new evidence; rather, the Appeals Board makes a determination based on the claim’s record. With a Request of Reconsideration, you and your attorney submit either new evidence or new legal arguments.
Although an insurance company may the party that ultimately pays out any compensation benefits, your employer always retains a stake in the outcome of your case because it will incur higher insurance premiums if you win. Therefore, your employer will likely be involved at all stages: it will answer your complaint, attend the trial, and have a representative testify. Understand the terminology. In other areas of law, a “trial” and an “appeal” are distinct events. For example, in the criminal arena, no witnesses appear at the appeal. Instead, an attorney writes a legal brief and no new evidence is admitted. However, in the workers’ compensation arena, the “appeal” is like a trial: witnesses are questioned and evidence is presented to an administrative law judge (ALJ) or to an appeals board.
In some states, the workers’ compensation claims board can request an IME. If you have an attorney, then the IME is scheduled per agreement between the insurance company and your attorney. [16] X Research source Though you and your lawyer can object to the IME, an objection will often be interpreted as a concession that the injury isn’t as severe as you are claiming. Try to have a friend or family member go with you. [17] X Research source By having someone go with you, you will have a witness in case the doctor testifies that you said or did something that you didn’t do.
Read up on other cases similar to yours. For example, if you were denied workers’ compensation benefits because your condition was “preexisting,” then you could research any prior appellate decisions that discussed preexisting conditions. A case where an appeal was granted in a factually-similar case is strong evidence in your favor that your claim is valid. Your attorney will be skilled in researching prior decisions. Ask her for copies of any decisions so you can read them.
Your state law may or may not provide for subpoena power. If it does, then you can get a blank subpoena form from your workers’ compensation board. Serving a subpoena is a way to assure a witness’s attendance. Fill in the subpoena form with the witness’s name and address. Then fill in where the witness is commanded to appear (i. e. , where the hearing will be held) as well as the date and time of the hearing. [19] X Research source Mail the subpoena using certified mail. Give the witness plenty of time (at least several weeks) to rearrange her schedule in order to attend.
Ask your attorney to do a practice run. Have your attorney pepper you with hard questions to familiarize you with the process. Review your summary of the event. Shortly after being injured, you should have jotted down what happened and how. Review this information to refresh your memory.
If you have any questions, you should ask them at that time. For example, you should ask if the other side has turned over copies of their witness list or the medical reports they intend to use.
Trials are rarely held at court houses. Rather, they are usually held at the offices of the workers’ compensation board. Dress neatly. Look professional but comfortable. You do not have to wear a suit if it makes you feel awkward. [21] X Research source
You should have practiced your trial testimony with your attorney. She cannot ask you leading questions (i. e. , questions that contain the answer). [24] X Research source But she can ask more general questions: “Where were you on the morning of…?” “Did you hurt yourself?” You will also be cross-examined. If you read you’re the answer, then you should have a good idea of what questions the other side will ask. For example, if your employer or the insurance company claims you were injured while on vacation, you should anticipate detailed questions about where you went and what you did.
Sometimes an appeals board will review the ALJ’s written order and either adopt its finding or send it back for reconsideration.
Appeals can also be handled on contingency. However, you may have to sign a new client agreement, which redefines the scope of the representation.
