In Oklahoma and Arkansas, people who are injured while they are working at their jobs are entitled to pursue benefits through their employers’ workers’ compensation insurance carriers. By filing a claim, injured victims may recover benefits to pay for all of their accident-related medical bills and a percentage of their incomes if they were left with temporary or permanent disabilities that prevented them from returning to their jobs. While most workers know that workers’ comp is available, they might not know how a workers’ compensation case works. Here is a brief overview of the process and what you might expect.
What to Expect from a Workers’ Compensation Case
Each year, millions of workplace injuries and accidents happen in the U.S. In 2019 alone, the U.S. Bureau of Labor Statistics reported that private employers reported 2.8 million nonfatal workplace injuries or occupational diseases. After a workplace accident or illness, injured workers should immediately report their injuries or illnesses to their employers. The employers will then report what happened to the insurance company and provide the worker with a claim form. While filing a claim is fairly straightforward, securing a settlement can be more difficult.
The Workers’ Comp Claim Process
Workers must report their injuries or work-related illnesses to their employers soon after they happen or risk losing the right to recover benefits. In Oklahoma, injured workers must report their accidents and injuries to their employers or obtain medical treatment within 30 days. In Arkansas, injured workers must report their injuries in writing to their employers as soon as possible.
Once the injury has been reported, the employer will give the worker a claim form to fill out. The employer will then submit the claim to the insurer. The insurance company will then investigate the claim to determine whether it should be approved or denied. This investigation might include contacting the employer, reviewing medical files, and reviewing accident reports.
Denial or Approval of Claims
In a workers’ compensation case, an insurer might deny a claim for one of the following reasons:
- Self-inflicted injury
- Injury caused by horseplay or fighting
- Injury happened during the commute
- Injury happened while the employee was under the influence or committing a criminal offense
People whose claims are denied have a right to appeal. During the appeals process, negotiations will continue between your attorney and the insurance company. If a settlement cannot be reached, your workers’ compensation case may go to a hearing before an administrative law judge.
What Happens If a Claim Is Approved?
If the insurance company approves your claim, you might be eligible for the following types of benefits:
- Medical expenses
- Rehabilitation expenses
- Physical therapy
- Transportation costs to and from medical appointments
- Partial income replacement while you are unable to return to work
- Partial or permanent disability
If you are deemed to be able to return to work and have received temporary disability benefits, they will end.
Settlements or Hearings
In some cases, insurers will deny workers’ compensation claims. However, your attorney can continue to negotiate with the company to try to secure a settlement. If a settlement is reached, you will receive benefits. However, if you and the insurance company cannot reach an agreement, your case will go to a hearing.
Typically, the insurance company and employer will initiate the settlement process by making an offer. A settlement might include a lump-sum payment or a structured payment plan. The insurance company and your attorney will calculate what a fair settlement should be and base their negotiations on those figures.
It can take weeks or months to negotiate a settlement. If a settlement cannot be reached, the case might head to a hearing. At the hearing, the judge will hear evidence and make a determination. If the amount of settlement is what is at issue, the court will decide what an appropriate settlement should be. The insurance company will then be bound to the court’s order and must follow it.
If the case heads to trial as an appeal of a denial, the judge will determine whether or not the claim should be approved. If the court decides the claim should be approved, the compensation amount will then need to be determined.
Get Help from a Workers’ Comp Attorney
The workers’ compensation claims process can be confusing. Working with an experienced attorney can help you understand what to expect and give you peace of mind. To schedule a free consultation, contact the Law Offices of Craig L. Cook by calling 479-783-8000 (Fort Smith) or 918-912-2132 (Tulsa) or sending us a message online.