Occupational illness claims can be difficult for many employees to understand. After sustaining an injury at work, workers want to file a claim as soon as possible. Unfortunately, when employees don’t know what they’re doing, they can mess up their claim. Here’s what employees should know before filing a workplace injury claim.
What’s inside:
- Understanding Workplace Injury Claims
- Occupational Illness Claims
- Common Denial of Claims
- How to File Your Claim
- Denied? Here’s What to Do.
Understand Workplace Injury Claims
Workplace injury claims aren’t complicated. An injury claim is simply when an employee asks the employer or insurance company to cover benefits due to a work-related injury.
Simple enough, right?
Yes and no. While workers’ comp is meant to help employees who are hurt on the job, the reality is that it often doesn’t work in the employee’s favor. According to the Bureau of Labor Statistics, employers reported over 2 million injury and illness cases in 2024 alone.
Once an employee is injured on the job, they need to act quickly. Each state has deadlines for both injury reporting and injury claims. If an employee doesn’t meet these deadlines, their claim can be denied from the start.
For employees who don’t know where to start or who want to ensure their rights are protected throughout the claims process, speaking with a workers comp lawyer in Fresno may be beneficial.
Ultimately there are two kinds of workplace injury claims that employees should be aware of.
Acute Injuries
These injuries happen suddenly, like breaking a bone, cutting yourself, or tripping.
While every injury is different, acute injuries tend to be cut-and-dry.
There’s an accident that causes the injury. The connection between the cause and injury is pretty clear.
Occupational Illness Claims
An occupational illness injury happens over time.
These types of claims can include respiratory problems, repetitive stress injuries, hearing loss from loud noises, and many others.
With these types of claims, there’s often a need for more evidence to support the work connection.
Occupational Illness Claims
Occupational illness claims are different from typical injury claims.
Why?
Because these types of claims are harder to prove.
With acute injuries, someone saw the accident happen. But with occupational illness claims, they develop over weeks, months, or even years.
Some common occupational illness claims include:
- Exposure to harmful chemical agents that lead to respiratory issues
- Constant loud noise exposure that causes hearing loss
- Repetitive tasks that cause strain
- Working with skin irritants that cause a rash or dermatitis
- Working in a stressful environment that leads to anxiety
With these claims, the problem is proving that the job is the cause of the illness. Employers will comb through medical records, work history, and any other documentation that can be provided.
The issue with these types of claims…
Employers often don’t track occupational hazards. So they don’t have records of exposure.
And some injuries can come from outside of work. Was the hearing loss due to work or those concerts from college?
Why Claims Get Denied
Did you know that approximately 7% of workers comp claims are denied each year?
When looked at one way, that doesn’t seem too bad. But with millions of workers comp claims each year, 7% equals about 700,000 employees who’ve had their claim denied.
Why do so many claims get denied? Here are the most common reasons:
Deadline not met
Time is everything with workers comp claims. Most states require that the injury be reported to the employer within 30 days.
Employees typically have between one and two years to file their claim. If an employee misses a deadline, their claim could be denied.
Incomplete/missing information
If an employee doesn’t have enough documentation, insurance companies have an easy reason to deny their claim.
Injury not work related
Insurance companies will deny claims if there’s enough evidence that the injury didn’t happen while on the job.
Employers know this happens a lot with occupational illness claims. That’s why gathering as much proof that the injury is work-related is vital.
Pre-existing condition
Believe it or not, insurance companies love arguing that an injury was caused by a pre-existing condition.
They’ll try to prove that the employee was injured before being employed and the new job just aggravated the injury.
Failure to properly report injury
Telling a coworker about a sprained ankle isn’t considered properly reporting an injury.
Employers need to be notified with specific forms. Submitting the correct paperwork to the correct person is crucial.
How To File Your Claim
Filing a claim doesn’t have to be difficult. If employees know the steps to take to file a claim correctly, they’ll be setting themselves up for success. Let’s take a look…
Notify the employer.
The first thing to do after receiving an injury or being diagnosed with an occupational illness is to notify the employer. Let them know what happened in writing and keep a copy for the records.
Go to the doctor.
Employees should always seek medical attention after being injured, even if the injury seems minor.
Medical records are what connect the injury to the job. Make sure the doctor notes in the records that the injury is work-related.
Take pictures.
If possible, take pictures of the injury and the location where it happened.
Write down exactly what happened as soon as possible. Take notes and even get a statement from witnesses if they were involved.
Follow through with medical treatment.
Insurance companies look for injury victims that miss work treatments and don’t follow doctor’s orders.
If employees want their claim to be approved, following medical advice is essential.
Meet deadlines.
Every state is different when it comes to injury reporting and claim filing deadlines.
Find out what the deadlines are and mark them on a calendar. Set multiple reminders if necessary. Deadlines are one of the easiest things to meet with proper planning.
Make copies.
This tip kind of goes along with notifying the employer, but employees should always make copies of any and all documents related to the claim.
Forms filled out, receipts, and any communication between the employee and the employer or their insurance company.
What To Do If The Claim Is Denied
Just because a claim was denied doesn’t mean that employees should give up.
In fact, many claims that get denied end up being awarded to the employee after an appeal. Employees who fight their denial have a pretty good chance of winning.
If a claim has been denied, here are the steps to take:
Read the denial letter.
When a claim gets denied, employees should receive a letter stating why the claim was denied. Read it carefully and make sure to understand why the claim got the axe.
Find more evidence.
If the claim was denied due to a lack of evidence, it’s time to start digging. Request more medical opinions, gather any missing workplace records, and even get more statements from witnesses.
File an appeal.
Don’t wait to file an appeal. Like with initial injury reports and claims, there are deadlines for filing an appeal as well. Get on that appeal as soon as possible.
Hire a lawyer.
Employees don’t have to go at this alone. Workers comp lawyers understand the ins and outs of workman’s comp claims. They know what evidence to gather and what to do next.
Most workers comp lawyers work on a contingency basis. This means that employees won’t pay them unless they win the appeal.
Don’t Give Up.
Insurance companies are counting on employees to just accept their denial and move on.
Employees fought this hard to get their claim approved. Stick with it.
Wrap Up
Filing a workplace injury claim is pretty straightforward.
The key is knowing what needs to be done to file a claim correctly. Employees dealing with occupational illness claims have a bit more of a challenge. Just remember these tips:
- Report the injury to the employer immediately and in writing
- Get medical help and make sure the medical records show the injury is work-related
- Know the state’s deadlines
- Document anything that can help connect the injury to work
- Don’t accept the denial of the claim
Workers compensation is there to help employees who were injured on the job.
Take the time to learn how to correctly file a claim and the future will be brighter for it.
