The Workers’ Compensation Process
Guidance While Seeking Workers’ Comp Benefits
How does the workers’ compensation process work? If you have recently been injured on the job, then you have certainly asked this question lately, but you might not have gotten a reliable answer. Our workers’ comp attorneys from Whiting Hagg & Dorsey, LLP would like to help shed some light on the situation, so you can best understand the workers’ compensation process here in South Dakota.
The average workers’ compensation claim process involves:
- Injury: Workers’ compensation only applies to injuries suffered by an employee at work or while they are completing job-related duties. If your injury was unrelated to your job, then your claim could be denied, and you will have to explore other avenues for compensation. It is important to note that a job-related duty does not need to be part of your normal day-to-day tasks and it does not have to be something that happens within your typical workplace. For example, if your boss instructed you to go pick up lunch for them, and you are hit by a negligent driver on the way back, then workers’ compensation would likely still apply.
- Report: Immediately after an accident, you should tell your supervisor or employer about your accident. In South Dakota, injured workers usually only have 3 business days to notify their employer, or their workers’ compensation claim can be denied outright. If you can’t tell your employer right after your injury because you are taken to the hospital, then you need to at least tell them the next day. You can call your workplace and speak with your supervisor or boss if this is the only option, but a written statement can be required. Once your employer knows about your accident and injury, they need to prepare a workers’ compensation claim with their insurance provider within 7 days in most cases.
- Medical care: You should also seek medical attention immediately after being in a work-related accident, even if you aren’t sure if your injuries are going to be covered by workers’ compensation. A gap in medical care can jeopardize your claim by giving the insurer a chance to say that your injuries are not related to your work or that you exaggerated them. If you need to be taken to the emergency room, then you will be brought to the nearest one covered by your employer’s insurance provider. Otherwise, you can go to an urgent care center of your choice if you have previously designated your choice of doctor with your employer. Many people choose to first go to their employer’s in-network medical provider for simplicity’s sake.
- Response: The workers’ compensation insurance company needs to provide a response to your workers’ comp report as soon as possible and reasonable, often within just one business day of receiving the report. The insurer will decide if your compensable, which means you are eligible for benefits based on your injuries and how they occurred. Ideally, your claim will be approved, and you can expect coverage for all necessary medical treatments and wage replacement benefits if you cannot work for 7 or more days in a row. Unfortunately, your claim could be denied or deemed not compensable.
- Claim: A workers’ compensation denial is not the end of your chances at receiving benefits, though. South Dakota allows you to file a claim or lawsuit against the insurance company within two years of the denial. At this point, you should work with a workers’ compensation attorney like those at our law firm if you have not already. Your case can be settled or litigated, which leaves the outcome up to a judge or, in rare cases, a jury.
How Long is the Workers’ Comp Process?
The length of the workers’ compensation process depends on how complex the case and whether or not the insurer wants to challenge your claim’s validity. If the insurer accepts your claim, then the process could be effectively finished within a week or so of your accident. If the insurer rejects your claim, then the process can take months or longer, depending on if you can reach a settlement or need to go to court.
Why Do Employers Fight Workers’ Comp Claims?
Insurance companies are not the only parties that can fight or complicate your workers’ compensation claim. Your own employer might try to make things difficult by arguing that your injury is not work-related. But why would your employer fight your claim if it is their insurer who pays for your benefits, not them? The truth is that some employers will fight a claim because it will likely raise their monthly insurance premiums each time a claim is filed and accepted.
Workers’ comp premiums work similarly to car accident insurance premiums, for example. If you get into a car accident that was partially your fault, then the amount of money you pay each month for the same coverage will go up. The more workers’ comp claims filed by an employer, the more money they have to pay to keep coverage.
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