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You could receive workers’ compensation benefits if a work-related incident hurt you or made you sick. These benefits help you recover and get back to work by covering the costs of your medical care and replacing a portion of your lost wages.
In Indiana, most employers must provide this no-fault insurance coverage, meaning you can claim benefits no matter who was at fault for your occupational injury or illness. In other words, you receive benefits as long as your injury or illness occurred due to a work-related incident or arose out of the course of your employment, regardless of whether you or someone else caused the injury or illness.
Even though workers’ compensation is a no-fault system, many injured workers still struggle to get the benefits they deserve. Some employees have difficulty proving their injuries are work-related, while some employers and insurance companies dispute claims despite solid evidence. This is why injured workers need experienced Indianapolis workers’ compensation lawyers who understand their rights when pursuing their claims.
Let’s explore who qualifies for workers’ comp benefits in Indiana, what workers’ comp benefits cover, how to file a workers’ comp claim, and how an attorney can help.
Who Can Get Workers’ Compensation in Indiana?
Indiana requires nearly every employer to carry workers’ compensation insurance on behalf of its employees. So, if you are a legal employee in Indiana and you sustain a work-related injury or illness, you are likely eligible for workers’ compensation benefits. And unlike some other types of insurance, workers’ comp insurance covers eligible employees from their first day on the job.
Under Indiana Law, certain types of workers are exempt from statewide workers’ comp requirements, meaning they are not eligible for benefits.
Workers who are exempt from Indiana’s workers’ comp law include:
- Railroad employees. Railroad and train service workers such as engineers, firefighters, conductors, brakemen, flagmen, baggagemen, and foremen, who instead may qualify for Federal Employers’ Liability Act benefits
- Casual laborers. Those who work irregular, unpredictable, sporadic, or brief jobs with no usual course of trade
- Agricultural employees. Employees who work on farms, ranches, or other agricultural facilities tending to crops or livestock
- Household employees. Employees who work in and around the home, such as housekeepers, maids, nannies, caregivers, cooks, assistants, and gardeners
- Real estate professionals. Licensed real estate agents who receive most of their pay from sales commissions and not the number of hours they work
- Independent contractors. Self-employed individuals who agree to provide goods or services to others as non-employees
- Government employees. Employees of federal, state, or municipal governments, including local police officers and firefighters
- Executives and owners. Sole proprietors, partners in business partnerships, owner-operators, executive officers, and members of limited liability companies
What should you do if you are injured in the workplace?
The Workers 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 workers 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 Workers 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.
What Does Workers’ Compensation Insurance Cover?
Workers’ compensation insurance covers work-related injuries and illnesses that occur during the course of a worker’s job duties, meaning injuries and illnesses that arise while a worker performs activities related to their job requirements.
This includes injuries and illnesses that happen when an employee works outside of designated work hours, performs tasks their employer did not explicitly assign, or works outside of their usual workplace. However, workers’ comp usually does not cover injuries or illnesses that arise during unpaid breaks or those that occur due to intentionally unsafe behavior or on-the-job intoxication.
There are five key types of workers’ compensation benefits in Indiana:
- Medical coverage benefits. Medical coverage pays for any medical expenses necessitated by a work-related injury or illness. These expenses can include the costs of hospital or doctor’s office visits, prescriptions, medical equipment, and related healthcare expenses. Remember that Indiana employers have the right to choose your doctor unless you seek emergency care. Also, if you have not received wage replacement benefits, you can claim your normal hourly wage for any time you must miss to attend medical appointments.
- Temporary disability benefits. Temporary disability benefits are a type of wage replacement benefit that provides weekly financial support while you are too hurt to work. In Indiana, these benefits begin after you miss more than seven days of work and pay two-thirds of your pre-accident wage, subject to a state-imposed cap. If you can work but in a reduced capacity, they pay two-thirds of the difference between your pre- and post-injury wages.
- Permanent disability benefits. Permanent disability benefits are a type of wage replacement benefit that compensates you for permanent partial or total disabilities arising from work-related injuries or illnesses. The value of permanent disability benefits depends on your average weekly wage, the extent of your disability, and the body part that your disability affects.
- Death benefits. Death benefits compensate your surviving family members if you die as a result of a work-related injury or illness. Death benefits help loved ones cover the costs associated with a worker’s death, such as funeral and burial expenses and the loss of the worker’s financial support.
How Do I File a Workers’ Compensation Claim in Indiana?
Take the following steps after an on-the-job injury or illness to start your workers’ compensation claim:
- Seek medical attention immediately. Getting prompt medical attention after a work injury is critical to your health and eligibility for workers’ comp benefits. Doing so allows your doctor to diagnose, treat, and document your condition. Any provider can treat you in an emergency, though your employer otherwise has the right to select your doctor.
- Be honest with your doctor. You must be fully honest and forthcoming with your doctor when seeking treatment for a work-related injury or illness. Your doctor will prepare the documentation and medical evidence necessary for your workers’ comp claim. If you are not honest or thorough when describing the nature or extent of your condition, your doctor may not have the accurate and complete information they need to support your claim.
- Contact a knowledgeable attorney. A knowledgeable workers’ compensation attorney can help you navigate Indiana’s workers’ comp system and protect your rights as an injured worker. A trusted lawyer will help you present your claim in the best possible light and avoid common missteps that could cost you time or money. An attorney can also represent you through the appeals process with the Workers’ Compensation Board if the insurer denies your claim or there are issues with your settlement package.
- Notify your employer promptly. Under Indiana law, you must promptly notify your employer of any work-related injury or illness. If you fail to do so and then apply for workers’ comp benefits, the insurance company could deny your claim. To be safe, report all work-related injuries and illnesses to your employer as soon as possible, even if you don’t think you will need medical care or miss work. If you are too hurt or sick to report your injury or illness yourself, ask a trusted friend or co-worker to deliver the notice for you. It’s a good idea to prepare a written, signed, and dated notice for your employer and retain a copy for your records.
- Follow your doctor’s care plan. You should closely follow your doctor’s care throughout your recovery. Not only will this ensure you get the medical treatment you need, but it will also demonstrate to the insurance company and your employer that you are serious about your health. Be sure to document your recovery journey in a “pain diary” so you can refer back to this record of your symptoms and treatments as needed.
- Get a second opinion if needed. If you have concerns about the diagnosis or treatment plan you received from your original doctor, you might want to seek a second opinion. You can get a second opinion at no cost if your workers’ comp doctor recommends surgery or decides that you have reached maximum medical improvement (MMI), the point at which additional treatment will not improve your condition. You can seek a second opinion for your workers’ comp claim in other circumstances as well, but you would be responsible for the cost.
- Gather documentation for your claim. Clear records demonstrate the extent of your injury or illness and the losses you suffer as a result. Collect your hospital bills, medical records, pay stubs, and any other documents that support your claim. Make copies of everything and keep the copies together in a secure, accessible location.
- Follow up with your employer. Your employer has seven days from receiving your notice to file an Employer’s Report of Injury Form with their insurer and to provide you a copy. Your employer’s insurer will then contact the Indiana Workers’ Compensation Board about your claim and begin investigations. If for any reason your employer does not submit their report, seek legal help immediately.
Am I Eligible for Workers Compensation?
Here are some general guidelines about who must provide workers comp and who is covered:
- Nearly all employees in Indiana, whether employed in the private or public sector, are eligible for workers compensation coverage.
- Businesses of all sizes are required to provide workers compensation benefits to employees.
- Part-time workers are eligible for workers 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 workers 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 workers compensation benefits should consult with a workers compensation attorney.
- Categories of Workers Not covered by Workers Compensation
- Certain categories of workers such as licensed real estate agents are not covered by Workers Compensation. The following worker categories do not get a chance to clam compensation.
- Independent contractors are not employees and are not covered by workers 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 workers 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 Workers Compensation Act. Railroad workers are covered by the Federal Employees Liability Act.
- A workers compensation attorney can evaluate whether you are entitled to claim workers 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 Workers 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 workers 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 workers 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 workers 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 workers compensation claim.
What Happens if My Employer Denies My Workers’ Comp Claim?
Far too many workers experience frustration and panic because their employers or insurers deny all or part of their workers’ compensation claims. If this happens to you, don’t lose hope. You still have options for getting the compensation you need, especially if you work with an experienced attorney.
There are many common reasons employers and their insurance companies deny workers’ comp claims, including:
- Insufficient medical evidence. If you didn’t visit the doctor promptly after the accident, you might not have the medical records necessary to support your claim. Similarly, the insurance company might deny your claim if you forget to include complete documentation of all your medical expenses.
- Failure to notify or file promptly. Your employer or its insurance provider might deny your claim outright if you forget to notify your employer of a covered injury or illness within 30 days or fail to file your claim within two years.
- Mistakes on benefits applications. Some injured workers receive claim denials due to minor, preventable mistakes, such as forgetting to attach medical records or explain which benefits they are seeking in their claims.
- Disputes over eligibility. Some employers and insurance companies deny claims due to eligibility disputes, arguing that the claimant is not an employee or that their injury is not truly work-related.
You may appeal if you receive a denial for your workers’ comp claim in Indiana. Your attorney can take pursue the appeal by taking these steps.
- First, file a Request for Assistance with the Workers’ Compensation Board to seek an informal dispute resolution process with the help of a Case Coordinator.
- Should the Informal Dispute Resolution not succeed, you can file an Application for Adjustment of Claim within two years, after which the Board will assign your case to a Single Hearing Member.
- If you disagree with the Member’s decision, you can request an appeal by filing an Application for Review by Full Board within 30 days.
- If you disagree with the Full Board’s decision, your attorney can help you appeal your case further by representing you in front of the Court of Appeals or the Supreme Court of Indiana.
How Can a Workers’ Compensation Lawyer Help Me?
If you feel uncertain about your rights as an injured worker or wish to dispute a workers’ comp claim determination, turn to a workers’ compensation lawyer.
They can help you by:
- Guiding you through the process of filing for workers’ compensation and explaining what you should expect at each step
- Helping you gather the evidence you need to support your claims, such as medical records, witness statements, and other proof of your injury or illness
- Preparing and completing the necessary claim paperwork, preserving and attaching evidence, and filing your claim with the insurance company
- Communicating with your employer and other parties on your behalf
- Negotiating with your employer or their insurance provider and advocating for your rights if they dispute your claim
- Representing you at hearings and presenting your case in front of the Workers’ Compensation Board or a judge if you need to appeal
The workers’ compensation process in Indiana is a complicated one. You can save yourself time and aggravation by working with an experienced workers’ compensation attorney from the start.