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How Does Filing A Workers’ Compensation Claim Work?

April 11, 2018By Niko Pothitakis

Most people are familiar with the fact that the workers’ compensation system exists; medical care and wage replacement payments are available to workers who experience an injury or illness on the job. Many workers, however, know little about the actual process of obtaining these important benefits. The system can seem confusing or overwhelming for those who are just getting started, especially during the difficult time after an injury. Here, find out more about how the process works and what you need to do today to protect your rights and obtain the maximum amount of compensation available.

Begin the Process by Reporting Your Work Injury or Illness

The first and most important step to filing a successful workers’ compensation claim begins with reporting the illness or injury to your employer. Iowa law allows workers 90 days to report the injury, but is best to notify your employer as soon as is possible. Benefits will be denied for injuries not reported within the 90-day window.

Most employers will have injured workers complete a written incident report regarding the details of the injury and its details. If your employer does not request this, injured workers should submit a report of their injuries in writing or via email. Keep a copy of the notice. This way, if a dispute arises later, there is documentation of the timeline.

Once an injured worker notifies his employer about a work injury, the employer should provide information about seeking medical care. It is very important to seek medical care; failing to do so will seriously undermine your claim as it may appear as no injury truly exists.

In Iowa, the employer has the right to choose the care provider. Employees should obtain care from an approved provider as much as is possible. Insurance carriers and employers may refuse to pay for care that is not in the approved network.

Iowa Employers Will File a First Report of Injury

From there, it is an employer’s responsibility to file the claim with the state commission. The law mandates that employers file a First Report of Injury within four days of receiving an injury report. This is done electronically with the Workers’ Compensation Commission. Additionally, employers must notify their insurance carrier so that they can begin the claim consideration. It is also possible for the insurance company to file the First Report of Injury.

If an injured employee suspects his claim is being ignored, or his employer does not have workers’ compensation insurance as the law dictates, it is important to contact an experienced attorney. It is still possible to obtain compensation in these situations, but the process would be different from a straightforward claim.

The Insurance Company Will Consider the Work Injury Claim

At this point, the employer’s insurance company (or the employer itself if they are self-insured) will investigate the claim to determine if the injured worker is eligible for benefits. Employees should expect the insurance company to:

  • Review medical records
  • Consider work history
  • Request a medical exam
  • Talk with witnesses to the accident or work conditions

Insurance companies are required to respond to all claims in a timely manner, so injured workers should expect to receive a decision on their claim soon after filing.

Appealing a Workers’ Compensation Claim Denial in Iowa

Hopefully, the insurance company approves a work injury claim and pays benefits promptly. Some claims will be denied, however. Insurance companies are out to protect their own interests, and they will attempt to avoid paying as much as possible—even by denying legitimate claims. In those cases, Iowa law allows injured workers to appeal the decision.

The state commission encourages employees to first appeal directly to the employer. The Iowa Guide to Workers’ Compensation states that many disputes can be resolved through open communication between employee and employer. When that fails, however, more official means are available.

Injured workers can initiate a contested case proceeding, which would send the issue to the Iowa State Workers’ Compensation Commission. A hearing is typically held for both sides to present their cases, and the injured worker would have the burden of proving that denying the benefits is incorrect. Claims’ decisions can be appealed through a number of levels, all the way up to the Iowa Supreme Court.

If you or someone you love has suffered a work injury, you may eligible for Iowa workers’ compensation benefits. At Pothitakis Law Firm, our experienced attorneys help injured employees understand their rights and fight for the benefits they both deserve. Call our office today to speak with a member of our legal team and schedule a free, no-obligation consultation.