How Long Does a Workers’ Comp Claim Take?

How Long Does a Workers’ Comp Claim Take?

When filing a workers’ compensation claim and asking your employer, “How long will it take for me to receive my check?” you may hear varied responses. In an ideal world, you can settle your workers’ comp claim within weeks. However, we do not live in an ideal world.

As someone who wants to get a settlement that covers your expenses and losses sooner rather than later, you might wonder about the typical timeline of a workers’ compensation claim. Below is some general information about how long it might take to settle a workers’ compensation claim. The best way to expedite the process and ensure you receive full benefits is to discuss the matter with an experienced workers’ compensation attorney.

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Claim Investigation in Workers’ Compensation Cases

Someone in the U.S. suffers an injury on the job every seven seconds. When a workplace accident occurs, the injured worker must report the injury to the employer within the time limits set by law in their respective state. In California, for example, employees must report their work-related injuries within 30 days to be eligible for workers’ compensation benefits.

When the claim is initiated, the case enters what is known as the investigative phase. Under California law, there is a presumption that the claimant’s injury or illness is related to work unless the insurance company denies the claim within 90 days of the date the employee submits completed form DWC 1 to their employer.

During the investigative phase, the insurance company’s claims administrator will review the claimant’s medical records, conduct interviews, speak to witnesses, and take other steps to make a decision on the claim. Generally, claim investigation in workers’ compensation cases can last from 14 days to a month.

Settling a Workers’ Compensation Claim vs. Going to Trial

The timeline of a workers’ compensation case also depends on whether you can settle your claim without a lawsuit or need to go to trial. For instance, in California, more than 600,00 First Reports of Injury (FROIs) are submitted to the Workers’ Compensation Information System (WCIS) annually. Most of these FROIs subsequently turn into workers’ comp cases. The vast majority of all workers’ comp cases in California are settled out of court. However, sometimes going to trial is necessary to maximize the compensation amount.

If you choose to settle your claim to get your first check faster, you risk losing some of the potential benefits to which you may be entitled. Yes, resolving the case without litigation can speed up the process, but a settlement needs to be fair and account for all your past, current, and long-term expenses and losses.

When in doubt about the right course of action, consider consulting a workers’ comp attorney who can review the facts of your case and help you make an informed decision.

Reasons for Delays in the Workers’ Comp Claims Process

After an injury, you probably want to get your workers’ compensation claim over with as quickly as possible. Unfortunately, sometimes, cases move through the workers’ comp system slower than you would like. Here are some reasons why a settlement may get delayed and how a lawyer can maneuver through the system more effectively to expedite the process.

Incomplete or Incorrect Paperwork

From initial filings to providing updates on medical treatment, each step involves a lot of paperwork. This usually demands attention to detail and meticulous adherence to complex regulations. However, a single page missing or an error in the form can grind the process to a halt.

How a lawyer can prevent paperwork woes from becoming a stumbling block:

• Organize your documents from the outset
• Keep duplicates for your records
• Double-check every form for completeness before submission
• Ensure accuracy of all information on your claim forms

Medical Evaluation Delays

Securing timely appointments or receiving necessary evaluations after a work-related injury can pose challenges to your workers’ comp case. Backlogs in the healthcare system, particularly in specialties related to workplace injuries, can lengthen the time between filing a claim and receiving a diagnosis.

What a lawyer might do if medical evaluations are holding up your claim:

• Advocate for your medical needs aggressively, requesting expedited appointments when suitable
• Keep detailed records of all communication with healthcare providers, insurers, and employer representatives

Allegations of Fraud

Workers’ comp insurance companies are vigilant against fraudulent claims, and rightly so. Unfortunately, this vigilance can sometimes result in legitimate claims being scrutinized under a cloud of suspicion. Even the appearance of impropriety, however unfounded, can lead to intense investigations, which can undermine the claim and prolong the process.

A workers’ comp attorney can address fraud allegations during a workers’ compensation case:

• Provide a clear and consistent account of the incident that caused your injury
• Consult a workers’ comp lawyer early in the process, especially if you anticipate a contentious claim
• Stay within the boundaries of your treatment plan and avoid activities that may cast doubt on your claim

Lack of Witness Statements

Third-party accounts can enhance the strength of a workers’ comp claim, particularly if the details corroborate the claimant’s version of events. However, securing timely and accurate witness statements may be difficult, especially if the incident occurred in a hectic or unsupervised environment.

Your attorney can work to overcome the absence of witness statements in a workers’ comp case by:

• Documenting as much as you can at the scene, even if you cannot collect statements from colleagues or anyone else
• Recording witness contact details for follow-up queries or testimony
• Being proactive in sourcing and persuading witnesses to support your claim

Disputes Over the Severity/Nature of the Injury

The subjective nature of pain and the sometimes invisible nature of certain injuries can lead to disputes with insurers over the severity and nature of the injury. These disagreements can cause delays as claim reviews turn into protracted negotiations.

How a workers’ compensation lawyer can deal with disputes during the claims process:

• Maintain consistent communication with your insurer and attorney
• Accumulate as much medical evidence as possible, including imaging and specialist reports
• Consult an attorney about the types of evidence that carry the most weight in proving your claim

Communication Gaps

Effective communication is the lifeblood of a successful workers’ comp claim. However, misunderstandings or breakdowns in communication between claimants, insurers, legal teams, and medical professionals can derail even the most diligently prepared claim.

Your attorney can eliminate communication gaps:

• Familiarize yourself with all the agreements involved in your claim (if necessary, have a workers’ compensation attorney explain the provisions)
• Seek to establish clear lines of communication
• Be persistent but also patient when awaiting responses or updates

Expediting the Workers’ Comp Claims Process

For many, the waiting game associated with a workers’ comp claim can be as stressful as the injury itself. The mere realization that it can take months until you get your first check can be frustrating. Fortunately, there are steps you can take to speed up the claims process to receive the benefits that are rightfully due faster.

Do Not Wait to File a Workers’ Comp Claim

How fast you report your injury and file a workers’ compensation claim is one factor affecting the duration of your case. Most states have a statute of limitations for reporting workplace injuries, with varying time frames depending on the injury’s jurisdiction and nature. As discussed earlier, in states like California, that time limit is 30 days from the date of the injury. Waiting too long not only risks the benefit of the doubt in proving the injury is work-related but can also prolong the process and your wait for benefits.

Here’s what you can do to expedite the process:

• Immediately report the injury to your supervisor
• Request the necessary forms from your human resources department for prompt submission
• Consult a workers’ compensation lawyer who can handle the process while you focus on initial medical treatment and recovery

The more swiftly you act, the quicker the investigation can commence.

Find Out Why a Delay Is Occurring

If you have already filed your claim and there has been a delay, it is critical to understand why. Common causes for holdups include missing documentation, an incomplete claim, disputes about the injury’s severity or cause, or general inefficiencies within the workers’ comp system. To pinpoint the issue:

• Contact your employer’s workers’ comp insurance carrier directly and inquire about the status of your claim and
• Track any correspondences or interactions to have a record of your efforts.

By identifying the root of the delay, your workers’ compensation lawyer can address the issue directly and with more clarity.

Collect as Much Evidence as Possible

The strength of an injury claim boils down to the evidence available to support it. For this reason, you want to begin building your case by documenting as much as possible. This may involve:

• Taking photos if your injuries are visible
• Securing witness statements from coworkers who may have seen the incident and
• Keeping detailed records of all medical treatment and related expenses.

Additionally, ensure that all interactions and communications with your employer, doctors, and the workers’ comp board are recorded and preserved. Remember: the more evidence you have, the less room there is for disputes that can slow down the process.

Facilitate Effective Communication

Clear and frequent communication is key to pushing your claim forward. Ways you can facilitate effective communication while your workers’ compensation claim is pending include:

• Staying in touch with your employer regarding your work status and any possible light-duty availability
• Informing your manager and HR if your doctor prescribes work restrictions
• Staying proactive in your medical care and communicating effectively with your healthcare provider to understand your diagnosis, treatment plan, and potential return-to-work timeframe
• Having your workers’ compensation attorney handle all communications with insurance companies

Remember to consult your attorney before engaging in any dealings that can impact your case or eligibility for benefits. This applies to returning to work while receiving benefits.

Go to All Doctor Appointments

Each medical appointment is an opportunity to strengthen your claim. For this reason, you might want to:

• Attend all scheduled doctor visits to assess and document the progress of your recovery and
• If there are any changes, such as the inability to adhere to prescribed treatments due to insurance complications, document these problems and keep all related paperwork.

Prompt and consistent medical care not only accelerates your healing process but also creates a clear medical history that links your injury explicitly to your work-related incident.

Do Not Wait to Hire a Workers’ Comp Attorney

Having an attorney in your corner can speed up the workers’ compensation claims process. Attorneys know workers’ compensation laws and the procedures involved in filing and managing claims like the back of their hands. An experienced attorney can predict potential obstacles during the claims process and advise you on maneuvering around them to receive the benefits you need faster.

As a rule of thumb, once the claimant hires an attorney, the claims adjuster is more likely to move forward to avoid potential litigation. Having an attorney on board from the beginning can help protect your rights in the case of more complex or disputed claims. A skilled attorney can pursue all avenues for quicker benefit resolutions, including litigation.

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