One area of the workers’ compensation claim process that is not well known is that when an employee is injured on the job, the employee must prove that he/she is entitled to and is eligible to receive workers’ compensation benefits. Since the initial burden of proof of eligibility is on the injured worker, an experienced workers’ compensation attorney can provide extensive assistance in compiling the necessary information at the very beginning of the claim process and making timely submittals.
In general, the items that must be proved in filing a workers’ compensation claim include, but are not necessarily limited to:
- That the injured employee notified the employer of the accident or injury within the time limit set by law.
- Showing that the employer was and was required to be covered under the Workers’ Compensation Act on the date of the accident.
- That the medical conditions for which benefits are being claimed was caused or aggravated by the on-the-job accident.
- That the injured was employed by the employer when the injury occurred. This is especially important for independent contractors.
- That the injuries were sustained while performing authorized work for the employer.
As with any program in which potentially large sums of money may be paid out, significant disagreements over initial level of eligibility or the continuation of eligibility can arise even after the initial proof of claim is properly documented and submitted.
Eligibility for initial or continuing benefits may be disputed over issues regarding, but not limited to:
- The type and severity of the injuries or disability
- The extent to which the employee’s claimed work restrictions are related to the claimed injury
- If the prescribed treatments were justified/required
- The submitted costs of treatment, therapies and medications
- If or if not the employee can perform his/her former job and what work is the employee capable of performing
- Terminated benefits and/or termination from employment
Providing counsel and expertise to resolve these and other areas of dispute is where a workers’ compensation lawyer can be of invaluable assistance. It is in any employee’s best interest to retain an experienced workers’ compensation attorney to advise and help the employee through the claim. A workers’ compensation lawyer is the advocate who has the expertise to help obtain the benefits to which the employee is legally due.