If it is approved, a workers’ compensation claim can take as little as a couple of weeks. However, if it is denied and you appeal that denial, the resolution process can last up to several years. Once the claim is accepted or denied, you will start receiving benefits. It can take longer for your claim to settle completely.
What is the workers’ compensation process?
While each state has its own workers’ compensation law, the process is generally the same:
- you get hurt at work,
- you get medical treatment from a healthcare professional, notifying them that it was a work-related injury,
- you notify your employer of your injury,
- you file a workers’ compensation claim,
- the workers’ comp insurance company conducts an investigation of the claim you filed, including looking at your medical records,
- during this time you may be able to return to work, often on light duty, if the severity of your injury is not extreme, and
- the insurance company either accepts or denies the claim.
If your claim is accepted:
- you will receive workers’ comp benefits, often every 2 weeks,
- you will continue to recover from the accident, and
- if you recover completely, the claim will be closed, or
- if you do not fully recover, your workers’ comp attorney will negotiate with your employer’s insurance company to settle your future workers’ compensation payments.
If your claim is denied, you have the right to appeal it. If you invoke this right:
- the denial will be reviewed by an administrative law judge at your state’s workers’ compensation division,
- if this review affirms the insurance company’s denial of benefits, there may be another level of administrative appeal, often with a panel of members at the workers’ compensation department,
- if this review also affirms the denial of benefits, you can appeal it to state court,
- if the judge on the state court also affirms the denial, you can appeal the decision to an appeals court, and
- if the appeals court also affirms the denial, you can request your state’s highest court to review the decision.
If your workers’ compensation case goes through all of these steps, it can take a long time to get resolved.
How long will it take if my workers’ comp claim is approved?
If the workers’ comp insurance company approves your claim after receiving it, your claim can end within a couple of weeks of your injury. However, if the insurance company conducts an extensive investigation before approving your claim, it can take longer. Additionally, different states have different timelines to follow. These can speed up or slow down the process.
After you get hurt, you have a limited amount of time to notify your employer. For example, in California you have 30 days to do so[1] while in Pennsylvania you have 120 days.[2] This timeframe is easy to understand if you were hurt in an accident. If you are suffering an illness or an injury that is getting steadily worse, you generally have to notify your employer as soon as it becomes clear that it is connected to your employment or you miss a day of work because of it.
If you fail to promptly notify your employer, you can lose your right to workers’ comp.
Your employer will then give you a claim form. You have a much longer time limit to fill out and return this form. In California, you have up to 1 year from the date of the injury.
Once you return the claim form to your employer, they will forward it to their workers’ comp insurance company. The insurance company then has a limited amount of time to conduct an investigation before accepting or denying the claim. In California, they have 90 days.[3] They are allowed to request more time to investigate. If the deadline passes and they have not approved or denied it, some state laws deem it approved.[4]
In many cases where the accident was clearly covered and the injury was work-related, the investigation will be quick. The insurance company may approve the claim within days. If you immediately notified your employer in these cases, your claim may be approved less than 2 weeks after the date of injury.
If there are doubts as to whether the claim is covered, it can take longer.
What if my workers’ compensation claim is denied?
If your claim gets denied, you have the right to appeal the denial. This prolongs the claim process. Depending on how many times an appeal is necessary to resolve the claim, it can take between a few months and several years.
The process varies by state. However, if your claim gets denied by the workers’ compensation insurer, your first appeal generally goes to your state’s workers’ compensation department. Typically, an administrative law judge will hear the case. This hearing is often several months after the insurance company’s denial.
If the administrative law judge affirmed the denial of benefits, you can typically appeal the case to a panel of members at the workers’ compensation department. They will review the judge’s decision. That review often takes several more months.
At this point, it is not uncommon for 1 year to have passed since you filed your claim for workers’ comp.
If the panel also affirms the denial of benefits, you can usually appeal your claim to state court. A judge at the trial court will review the panel’s ruling. It is not uncommon for 1 year to pass between the panel’s hearing and the trial court judge’s ruling on it.
If the trial court’s ruling also affirms the denial of benefits, you can appeal to your state’s appellate court. Several judges there will review the trial court judge’s decision. This appellate review often takes well over a year.
Some states, especially those with small populations, only have 1 level of appeals courts. Others have 2. If your state has 2 levels of appeals court, you can request the state’s highest court – often called the state supreme court – to review the appellate decision. Depending on the court’s docket, this can take between 1 and 2 years.
Once it is approved, what benefits will I receive?
If your workers’ comp claim is approved, you will receive:
- medical benefits, and
- disability benefits.
These disability benefits cover a portion of your lost wages. In most states, you are entitled to 66 percent, or two-thirds, of your reduction in wages.[5] These come in temporary disability benefits while you recover. If you reach maximum medical improvement (MMI) and are still disabled, they become permanent disability benefits.
The medical care for your work injury is covered by your employer or the workers’ comp insurance carrier. However, you will have to go to healthcare professionals approved by your employer.
When will I receive my workers’ compensation settlement?
Workers’ comp claims can reach a settlement for future benefits. They can settle at almost any point after the claim has been filed by the injured worker. However, they generally settle over a year after the claim was approved.
Workers’ comp settlement agreements can come in 2 forms:
- compromise and release, or
- stipulation and award.
The compromise and release is more common. In these, your workers’ compensation attorney and the insurance company negotiate a lump sum payment. This payment reflects the total future value of the claim. This includes all of the future and unpaid workers’ compensation benefits for you and your dependents, including:
- medical expenses, and
- disability benefits for future wage reduction.
These settlements are often struck after you have reached MMI. At that point, it becomes clearer what you would receive well into the future.
Once reached, though, these settlements end your case. If the lump sum payment is not enough to cover your losses, it is extremely difficult to reopen your case.
A stipulation and award settlement is rare. It stipulates the level of impairment and your disability benefits. The insurance company then makes ongoing disability payments. It also continues to cover your medical bills from your workplace injury.
Injured employees who establish an attorney-client relationship and get the legal advice of an experienced workers’ compensation lawyer from a reputable personal injury law firm can make an informed decision about settling their workers’ comp case.
[1] California Labor Code 5400 LAB.
[2] 77 Pennsylvania Consolidated Statutes 631.
[3] California Labor Code 5402(b)(1) LAB.
[4] Same.
[5] See, for example, California Labor Code 4653 LAB.
