In my 16 years of helping injured workers navigate their workers' compensation claims, I've handled all kinds of different cases and helped people get the compensation they deserve. If I found myself filing my own workers' comp claim today, here are the steps I would take.
Taking the right steps early on is key to looking after your health and protecting your claim. Here’s what to do right away:
1. Get Medical Help ASAP
Your health is the number one priority. If you’re injured, don’t wait—get medical care right away. For serious injuries, call 911 or head straight to the hospital. Worry about the paperwork later; your well-being comes first. And remember, no photo or piece of evidence is worth putting off medical treatment. Getting treated quickly not only helps you heal faster but also creates a solid medical record of your injury.
2. Let Your Employer Know
Once your immediate medical needs are handled, the next step is to tell your employer about the accident. In places like New York, you’re required to give written notice within a certain timeframe—30 days in this case. Don’t stress about making it formal; a quick text or email explaining what happened, when, and where is usually enough. This step is critical because it alerts your employer to notify their insurance company, which gets your claim rolling.
3. Gather Evidence
After things have settled a bit, start collecting anything that can back up your claim. If you’re able, take photos of the scene, any equipment involved, and your injuries. Talk to witnesses and get their names and statements. Save any related documents, like medical records, receipts, and communications with your employer. Memories fade and evidence can disappear, so the sooner you document everything, the better.
Once you’ve handled the immediate stuff after your injury, it’s time to officially file your workers’ comp claim. This part is all about getting the paperwork right so you can get the benefits you’re owed. Here’s how to make it as smooth as possible:
1. Be Thorough and Accurate
When filling out the claim form, double-check everything and make sure it’s spot-on. No shortcuts here! Be specific about what happened, where it happened, and what parts of your body were injured. Even small differences between what you tell your doctor and what you put on the form can give the insurance company a reason to challenge your claim. The more clear and detailed you are, the less hassle you’ll face down the line.
2. Be Honest About Your Medical History
If you’ve had an old injury or condition that affects the same part of your body, don’t try to hide it. It might feel like you’re giving the insurance company ammo, but being upfront is way better than them discovering it later and using it to argue against you. Insurance companies love finding reasons to deny claims, and a past injury you didn’t mention could be one of them. Be straight with your doctor, lawyer, and the insurance company—handling it now avoids bigger headaches later.
3. Talk to a Lawyer Early
Workers’ comp claims can get complicated, and having a lawyer in your corner can really help. An experienced attorney can guide you through the process, spot potential issues, and deal with any pushback from the insurance company. A lot of states offer free consultations with workers’ comp lawyers, so there’s no harm in getting advice early on. Even if your case seems simple, having a pro involved can give you peace of mind and make sure you’re doing everything right from the start.
Getting the right medical care is not just about seeing any doctor; you need someone who knows the ins and outs of work-related injuries and the workers' comp system. Here’s how to handle this:
1. Pick the Right Doctor
Not every doctor who takes workers' comp cases is the right one for you. You want someone who’s experienced in treating workplace injuries and is great at documenting everything. Good care helps you recover and makes your claim stronger. If you’re not sure where to start, ask your lawyer for suggestions—they often know doctors who specialize in workers' comp cases.
2. Get Treatment Approved
Dealing with insurance approvals can be a pain. Sometimes they drag their feet on okaying surgeries, tests, or therapy, which can slow you down. Make sure your doctor’s office knows how to handle workers' comp paperwork and can push for approvals when needed. If things are getting stuck, your lawyer can step in and help move things along.
3. Work With Your Doctor
Your doctor’s reports are a big deal for your case, so keeping a good line of communication is a must. Make sure they know exactly how your injury happened and how it’s affecting your life. If you’ve had any prior injuries, be upfront so they can separate those from your current work-related problem. And don’t be shy about asking questions—like what your recovery will look like, what your treatment plan involves, and whether you have any work restrictions.
4. Keep Documentation on Point
Workers' comp claims are all about the paperwork, so detailed medical records are key. Your doctor needs to include all the details about your symptoms, what’s limiting you, and how your treatment is progressing in their notes. If the records are vague or incomplete, the insurance company might use that against you. Double-check that everything is being documented properly.
5. Don’t Be Afraid to Get a Second Opinion
If you’re not improving like you thought you would or you’re unsure about your doctor’s recommendations, it’s totally fine to get a second opinion. Another doctor might have fresh ideas or confirm that a specific treatment is necessary. Your health comes first, so don’t hesitate to explore other options if something doesn’t feel right.
Independent Medical Exams (IMEs) are a normal part of the workers’ comp process, but they can feel a bit nerve-wracking. The insurance company sets these up to get another doctor’s opinion about your condition—one they choose—so the results might not always be in your favor. Still, with the right prep, you can make sure the process is fair. Here’s what you need to know:
1. Get Ready for the Exam
Before the exam, take a minute to go over your medical history and jot down your symptoms, how the injury happened, and the treatments you’ve had. You don’t need to remember every single detail, but having a clear idea of your condition will help you explain things better. Stick to the truth—don’t exaggerate your symptoms, but don’t downplay them either. Be honest about your pain and how it’s affecting your life.
2. Handling Scheduling Problems
You’ll usually get a few weeks’ notice about an IME, but if the date doesn’t work for you, try to reschedule as soon as you can. Skipping the exam without notice can make it look like you’re not cooperating, and that could hurt your case. If you have a conflict, let your lawyer know right away so they can help sort it out. Whenever possible, show up for the exam unless it’s absolutely unavoidable.
3. What Happens During the Exam
An IME is usually pretty quick—about 10 to 30 minutes. The doctor will probably ask about your medical history, how you got hurt, what symptoms you’re dealing with, and how your injury impacts your daily routine. They’ll also do a physical exam, which might include simple tests like checking your range of motion or strength. Just answer their questions honestly and keep your answers short and to the point—no need to share extra details unless they ask.
4. Pay Attention to the Details
During the exam, notice what the doctor does. Do they use tools like a goniometer to measure your range of motion? How long does the exam take? What tests do they perform? These details can come in handy if the report you get later doesn’t match what actually happened. In some places, you might even be able to record the exam if you let the doctor know ahead of time. Check with your lawyer about whether that’s allowed in your area.
1. Get Your Paperwork in Order
Start by pulling together everything you’ll need—medical records, accident reports, pay stubs, and anything else that backs up your claim. Your medical records should show what your injuries are, what treatments you’ve had, and what you’ll need going forward. Don’t forget to include all your income, like tips, overtime, and bonuses, so your average weekly wage is calculated right. Accurate wage info is key to making sure you’re fairly compensated for lost wages and potential future earnings.
2. Understand Your Injury and Disability Rating
Your disability rating is a big deal when it comes to your settlement. This number, given by a doctor, shows how severe and lasting your injury is. A higher rating usually means a bigger settlement. If you think the insurance company’s evaluation is off, you can always get a second opinion. Look for a doctor who knows your state’s workers' comp rules—they’ll be able to give you a more accurate assessment.
3. Be Ready to Negotiate
Insurance companies often start with a low offer—it’s a common tactic to save money. Don’t jump at the first number they throw out. Think about the full value of your claim, including ongoing medical needs and future expenses. Your lawyer can help you counter with an offer that better reflects what your case is worth. Fun fact: negotiating instead of accepting the first offer can sometimes boost your settlement by up to 150%.
4. Know the Rules and Deadlines
When it’s time for your settlement hearing, a judge will look at your agreement to decide if it’s fair. Once it’s approved, there’s a 10-day cooling-off period where either side can back out. Make sure you’re clear on all the legal steps and deadlines to keep things moving smoothly and avoid delays.
5. Time Your Settlement Right
Timing can make a big difference in what you get. Settling too soon—before you’ve hit Maximum Medical Improvement (MMI)—can leave you shortchanged because you might not know the full impact of your injury yet. On the flip side, waiting until after a permanency hearing could limit your ability to negotiate. The sweet spot is often when your future medical needs and level of disability are becoming clearer but before a judge finalizes your disability rating.
6. Show Why Future Medical Costs Matter
A big part of your settlement is for future medical care. Be ready to explain why you’ll need ongoing treatment and how it affects your ability to work. Detailed medical evidence, like a prognosis or care plan, can help show why your settlement should cover those costs.
7. Stay Cool at the Hearing
At your settlement hearing, keep calm and professional. The judge is there to review the facts, so make sure your case is clear and backed by solid evidence. Lean on your lawyer’s advice and focus on the key points that support your claim. Staying composed and focused will go a long way in helping your case.
After your workers’ comp case wraps up, getting back to work can look different depending on how you’re healing and the type of injury you had. If you’ve fully recovered, you’ll probably just go back to your old job like normal. But if you have a permanent disability, you might need to return with medical restrictions. In that case, your employer might offer you a light-duty position. If the new role pays less than what you were making before you got hurt, you could be eligible for reduced earnings benefits to make up some of the difference.
If your employer can’t give you a job that works with your restrictions, you might need to look for a new job or even go through vocational rehab to help you find something that fits. Make sure to stay in touch with your doctor and lawyer during this process so you can get any additional compensation you’re owed for a permanent impairment. They can also help you handle issues like job discrimination or if your condition gets worse after you’re back at work.
If you have questions or need some guidance, I'm here to help. I've seen just about every type of workers' compensation case there is, and I’m happy to share my experience to make sure you get the benefits you deserve.
Feel free to give me, Rex Zachofsky, a call at 212-406-8989. We can talk through your situation and figure out the best way to move forward.
