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What Are the Processes Involved in a Workers Compensation Claim?

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If you get injured on the job, there are some steps to receive your workers compensation benefits. To achieve this, you will need to follow the proper claims process, and you must submit the paperwork within the deadline to get your claim approved.

The employer must help the employee with the necessary paperwork and report the injury according to the provisions of Alabama law. Afterward, the employer must file a claim with the insurer, but note that the process may vary slightly from other states.

What Constitutes a Valid Workers Compensation Claim?

In Alabama, it is essential to ensure your claims are valid before submitting them to the insurer. To ensure validity, the victim must show that they sustained the wounds while carrying out an official duty or a function within the job scope. The injuries include diseases, accidents, or illness due to exposure to certain substances or chemicals.

The employer must also have a workers’ comp policy, and the injured individual must be a full-time employee and not a contractor. If the injuries are self-inflicted or occurred as a result of a violation of company policies, then the employee’s claims are invalid. Injuries as a result of illegal acts such as driving under the influence or psychiatric injuries are also not covered under workers’ compensation.

How to File a Claim

When filing a workers compensation claim, there are some procedures to follow to show eligibility and receive the benefits. Below are the required steps:

1. Report the Injury

After an injury occurs, ensure you get the necessary medical treatment and a formal medical report. The wounds must be work-related for the claim to be valid. Various forms of injuries are covered as long as they occur on the job and are not due to the employee’s negligence. After getting the necessary medical treatment, the employee must submit a report of the injury to the employer.

Depending on the insurance company, employees may need to receive medical treatment from a healthcare provider that is part of the insurance provider’s network before they can get benefits. It is essential to notify the employer through a written notice as soon as the injury occurs as there are deadlines for reporting injury claims.

Some states allow not more than 30 days, others give two years, but in Alabama, you must report the incident within five days. While some injuries or diseases sustained on the job may manifest over time, the employee must report the damage as soon as they begin to have visible symptoms.

2. Get the Necessary Paperwork from Your Employer

After notifying the employer through a written report, the employer is obligated to give you the needed reporting forms for the workers’ comp insurer, and the state workers comp personnel. The documents cover the employee’s rights and benefits, how the incident occured, and the nature and severity of the injury sustained.

If possible, the employer should provide the needed information even before the employee gets medical treatment. Some employers inform new employees about their workers comp process and benefits at the point of employment.

3. File the Claim

Usually, the employer will file the claim on the injured employee’s behalf. The employer must submit the necessary paperwork to their workers compensation provider. However, the employee’s healthcare provider will need to send a medical report containing details of the injury to the workers comp insurance provider. The employer may also need to submit the paperwork to the Workers’ Compensation Department of the Alabama Department of Labor.

The Claim Either Gets Approved or Denied

After the employer has filed the claim with the workers compensation insurer, the insurer will examine the case and either approve or deny the request. If the insurer greenlights the claim, they will send payment details to the employee, and if the insurer denies the claim, the employee can ask for a review or appeal the case.

Also, even if the request gets approved, the employee can either accept the compensation or negotiate a larger settlement or lump sum. After the process is complete, the employee may return to work once they have fully recovered and are willing to return.

Need Help with Your Workers Comp Claim? Contact a Mike Bell Lawyer Today

The workers compensation process is filled with complications. If you were injured on the job, you may need extra help to get the benefits you deserve. Contact a Mike Bell workers’ compensation attorney to review your case and get the help you need.

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