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The Worker’s Compensation Claim Process
How to Make a Claim
If you have been injured on the job in Indiana, your employer’s worker’s comp insurance should cover your medical care and pay a portion of your lost wages if you are out of work for a long time and exhaust your sick leave. The Indiana Worker’s Compensation Act entitles an employee who is injured on the job or develops a work-related disease to paid medical care and other benefits. The treatment must be medically necessary. In most cases, the employer designates a doctor to treat the worker’s injuries. In cases of emergency, the injured employee may go to the nearest hospital or doctor’s office for treatment.
The worker’s compensation attorneys at Klezmer Maudlin, PC are strong advocates for injured workers. If you are finding it difficult to get worker’s compensation benefits or your claim has been denied, call us for a free consultation. Attorneys Randy Klezmer and Nathan Maudlin have been representing injured Indianapolis workers for more than two decades. We have put together some general information below about how to file a worker’s compensation claim in Indiana. From handling thousands of cases, our attorneys have developed a thorough understanding of this area of Indiana law. In fact, we wrote the Indiana Worker’s Compensation Law and Practice manual, a legal reference book that other attorneys rely upon for guidance. If your employer is disputing your claim for benefits, one of our attorneys is available to discuss your injury and legal rights during a free consultation. We will review the details of your work-related injury or illness and explain your legal options and how to file a workers compensation claim and get comp insurance. Understanding your legal options will help you make a better-informed decision.
What should you do if you are injured in the workplace?
The Worker’s Compensation application process includes multiple administrative steps and deadlines that you must comply with to avoid having your claim delayed or denied. It is important that you get an understanding of the following steps:
- report your injury promptly by giving a written notice to your supervisor or human resources office
- ask your supervisor or employer to provide a doctor to treat your work-related injury
- seek immediate medical attention for your injury, and inform the doctor that your injury occurred while you were at work
- be sure to follow the doctor’s instructions and keep any follow-up appointments. (Do not return to work until you are cleared to do so. Your employer is responsible for paying your medical bills. The health care provider cannot charge you separately for authorized treatment for an on-the-job injury.)
Keep a copy of your injury notification letter and any correspondence with your employer and the insurance provider regarding your worker’s compensation claim.
You can get comp insurance for injury that occurred at the workplace.
The employer is required to file an injury report with the Indiana Worker’s Compensation Board if a workplace accident results in an employee missing more than one day of work. Request a copy of the accident report filed by your employer.
Am I Eligible for Workers Compensation?
Here are some general guidelines about who must provide worker’s comp and who is covered:
- Nearly all employees in Indiana, whether employed in the private or public sector, are eligible for worker’s compensation coverage.
- Businesses of all sizes are required to provide worker’s compensation benefits to employees.
- Part-time workers are eligible for worker’s compensation if injured in the workplace.
- Employees who are working in another state or outside the U.S. when an injury occurs are eligible for worker’s compensation benefits as long as there is an Indiana employment relationship.
- Workers who have been injured on the job and then told they are not eligible for worker’s compensation benefits should consult with a worker’s compensation attorney.
Categories of Workers Not covered by Worker’s Compensation
- Certain categories of workers such as licensed real estate agents are not covered by Worker’s Compensation. The following worker categories do not get a chance to clam compensation.
- Independent contractors are not employees and are not covered by worker’s compensation. But there are special rules that apply to independent contractors working in construction trades. The rules for determining who is an independent contractor are complicated. If you have been injured on a construction job and denied worker’s compensation benefits, you should talk to an attorney about your legal rights.
- Railroad workers including railroad engineers, firemen, conductors, brakemen and flagmen are not covered by the Indiana Worker’s Compensation Act. Railroad workers are covered by the Federal Employees Liability Act.
A worker’s compensation attorney can evaluate whether you are entitled to claim worker’s compensation or other types of compensation.
What benefits can I receive?
There are four basic types of benefits available for injured workers in Indiana:
- medical care including doctor visits, hospital care, medications, rehabilitation and physical therapy.
- wage replacement benefits if your injuries prevent you from working (These benefits are paid in weekly installments.)
- compensation based on the severity of the injury for permanent impairments if you lose the use of a body part as a result of your work-related injury
- death benefits paid to the dependents of an employee killed in a work-related accident
How do I report my work-related injury?
If you have been hurt in a workplace accident, you are required to notify your employer within 30 days of your injury.
You should inform your supervisor verbally as soon as possible and then send a written notification to the company human resources office. If your injuries prevent you from doing this, you should ask a family member to send a notification letter on your behalf. Keep a copy of the letter along with other documents related to your injury.
The quicker you inform your employer of your on-the-job injury, the sooner you may start receiving benefits. This is how an employee starts the compensation process.
What to expect from an investigation?
If you have a disputed claim and you request assistance, the Ombudsman assigned to your case by the Department of Worker’s Compensation will do a brief investigation to establish the facts and what issues are in dispute. The Ombudsman will contact both the injured worker and the employer or insurance provider to try to resolve the accident.
An insurance company or the employer also may hire a private investigator to do an investigation the employee and injury. This type of investigation is done to gather evidence to show that your injury is not real and to deny or terminate your worker’s compensation benefits.
Our advice to workers applying for compensation: Do not perform any activity that goes beyond the physical restrictions set by the doctor who is treating you.
Insurance company investigators may even monitor workers’ social media activity such as Facebook and Twitter looking for photos to use as evidence that prover workers are not as injured as they claim. Even an innocent photo of an employee holding a child or grandchild up in the air may be taken out of context and used against the employee, for example, if you are seeking benefits for a shoulder or rotator cuff injury. Avoid posting any comments on social media about your injury or worker’s compensation claim. Be careful about posting photos on social media such as vacation photos that can be misinterpreted.
Do not sign a release allowing an insurance investigator to have access to your complete medical file without consulting first with a worker’s compensation attorney. The investigator may want to rummage through your medical records looking for an old injury or pre-existing condition to use as grounds to deny the worker’s compensation claim.
What to do if your worker’s compensation benefits are being terminated
If the employer or the insurance company notifies you that you are sufficiently recovered to return to work and your disability benefits are being terminated, you will receive a Notice of Claim Status/Request for Independent Medical Evaluation form. This is also known as a 1043 form.
A doctor may be appointed to do an independent evaluation of an injured employee if the employer and employee disagree about the employee’s fitness to return to work after an injury.
If you disagree with the doctor’s determination of your readiness to go back to work and the proposed termination of disability benefits, you can request an independent medical examination. To do so, you should fill out the form and mail it to the Worker’s Compensation Board within 10 days of receipt.
The doctor selected to conduct the independent medical examination will be chosen from a list of specialists maintained by the Indiana Board of Worker’s Compensation. The Board typically orders the employer to pay for the examination.
The doctor will provide a written opinion regarding the injured employee’s condition. The Board will then determine whether the employee is ready to return to work.
What to do if your claim is denied?
Workers’ compensation claims are handled initially by employers in Indiana or the employer’s insurance provider. Most claims are settled without a dispute. But if a dispute arises about a claim or you disagree with the termination of your benefits, you may file a claim with the Indiana Worker’s Compensation Board.
The Ombudsman division of the Indiana Worker’s Compensation Board may be able to help informally to resolve a disagreement between you and your employer. If the Ombudsman is unable to settle the dispute, workers have a right to request a formal hearing before a worker’s compensation judge.
You may request a hearing by the Worker’s Compensation Board by filing an Application for Adjustment of Claim and submitting it to the Worker’s Compensation Board. You are not required to have an attorney represent you at a hearing. It is recommended that the injured worker has an attorney.
To comply with the statute of limitations in the Indiana Worker’s Compensation Act and be eligible for benefits, workers must file an Application for Adjustment of Claim within two years of the date of the injury. The calculations of time limits can be very complicated. You should consult with an attorney if there is a dispute about the time limits of a worker’s compensation claim.
A worker’s compensation judge may order that an injured worker receive medical treatment and may approve compensation for a temporary total disability, permanent partial impairment or permanent total disability.
If you disagree with the decision of the worker’s compensation judge, you have 30 days to file an appeal to have the full Worker’s Compensation Board review your case. The full board reviews the evidence presented at the initial hearing. The board meets in Indianapolis seven times per year.
If you wish to appeal the final decision of the Indiana Worker’s Compensation Board, you may ask the Indiana Court of Appeals to review it. It is strongly recommended that you use an attorney. If an insurance company or employer appeals an award of benefits by the Board and the Court of Appeals affirms the award, the amount of the award will be increased by five percent. The Court of Appeals has discretion to increase the award by 10 percent.
Do I need to consult a lawyer?
If your employer disputes or denies a claim for medical treatment after a workplace accident, you may be unsure how to proceed. You may be uncertain of your rights. That is a very typical situation.
You have a right to consult with an attorney at any time regarding your worker’s compensation issues. This is a basic right every employee possesses.
An employee has a right to challenge an employer’s denial of your worker’s compensation benefits and to request a hearing. An attorney can represent the employee in negotiating a compromise settlement and in presenting evidence at a hearing.
An employee also has a right to challenge a doctor’s determination to send the employee back to work after an accident and discontinue your disability benefits.
The Indiana worker’s compensation system is complicated, with numerous rules about notification and deadlines to meet. If you represent yourself at a hearing before the Board of Worker’s Compensation, you may make a misstep that will harm your chances of obtaining benefits. For example, an attorney may be unable to cite certain evidence on appeal because you failed to introduce it during the initial hearing. Our worker’s compensation attorneys can pursue benefits on your behalf while you focus on recovering from your injuries.
You may have other legal options as well. The Indiana Worker’s Compensation system generally bars injured workers from suing their employers for workplace injuries. But you may have a right to file a personal injury lawsuit and seek compensation from a third party such as or the manufacturer of a defective piece of machinery that caused your injury or an at-fault motorist who caused your injuries while you were driving on the job. A knowledgeable Indiana worker’s compensation attorney can review the specific facts of your injury and discuss the possibility of pursuing a personal injury lawsuit and help you with how to file a workers compensation claim in Indiana.