July 16, 2014

I Filed a Workers' Compensation Claim - What Happens Next?

I Filed a Workers' Compensation Claim - What Happens Next?

So, you have filed a workers' compensation claim using an 801 or 827 Form and are wondering what happens next...

The first thing to remember is that the workers' compensation insurer now has 60 days to accept or deny your workers' compensation claim.  I recommend marking 60 days on your calendar immediately.

While your claim is being investigated and processed, you should receive medical benefits and time loss.  If your claim is accepted, these benefits will continue.  If it is denied, they will end unless you successfully appeal your denial with a workers' compensation attorney.  You should expect to provide an recorded interview about your injury and go to an exam set up with a doctor working for the workers' comp insurer.  These are standard procedures for investigations of workers' compensation claims.

There are three scenarios that may come next:

Claim Accepted

First, your claim may be accepted.  This is the best-case scenario.  If this happens you should receive all your benefits including time loss and medical care.  However, you do want to make sure your claim is properly accepted.  The Initial Notice of Acceptance will state what conditions that claim is accepted for (i.e., low back strain, etc).  If the condition(s) is incorrect or does not include all your injuries, you will want to contact a workers' compensation attorney for assistance.

Claim Denied

Second, your claim may be denied.  If this happens you will receive a letter stating it is a "denial."  If you receive a denial, you will want to immediately contact a workers' compensation lawyer to help you appeal the denial.

Unfortunately, it is pretty common for workers' compensation claims to be denied.  If this happens, don't worry, but do call a lawyer.

You Hearing Nothing

Third, you may hear nothing about your claim after you file it.  This happens sometimes when claims get lost or the employer fails to comply properly with the law.  If it has been 60 days and your claim has not been accepted or denied, your claim becomes "de facto denied."  This basically means that the insurer - by doing nothing - has denied your claim.

In this scenario, you will definitely need a workers' compensation lawyer to help you appeal the "de facto denial."

As always, feel free to call for a free consultation with a workers' compensation attorney: (503) 975-5535


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