Understanding the Workers' Compensation Process as Explained by FindLaw

Filing the Initial Claim

The first step is to notify your employer of the injury promptly, typically within 30 days, and then submit a claim form to the state workers' compensation board. Include details of the incident, medical diagnosis, and any supporting documentation.

Employer and Insurance Review

After the claim is filed, the employer's insurance carrier reviews it for completeness and may request additional evidence. The insurer can either accept the claim, offer a settlement, or dispute it, citing lack of coverage or causation.

Medical Evaluation and Treatment

Claimants must see a medical provider approved by the insurer or designated by the state. The provider assesses the injury, documents treatment needs, and issues a report that influences benefit eligibility and wage‑loss calculations.

Benefit Determination

Benefits are categorized into medical benefits, wage replacement, and disability payments. Medical benefits cover necessary treatment; wage replacement typically equals two‑thirds of the average weekly wage; temporary or permanent disability benefits depend on the injury's severity and duration.

Dispute Resolution and Hearings

If the insurer denies the claim or offers inadequate benefits, the claimant can request a hearing before an administrative law judge. Both sides present evidence, and the judge issues a binding decision, which may be appealed to higher courts.

Closing the Claim

The claim concludes when the employee reaches maximum medical improvement, returns to work, or receives a settlement. Any future related issues usually require a new claim or amendment.

Key Timeline Overview