How Long Does It Take to Get Workers’ Comp Benefits?
Understand the typical process and timing involved in receiving workers’ comp benefits, from claim filing to potential delays and resolutions.
Receiving workers’ compensation benefits can be crucial after a workplace injury, but navigating the process raises questions about how long it takes to receive assistance. Delays in medical coverage or wage replacement can cause significant financial strain during recovery.
This article outlines the factors influencing the timeline for workers’ compensation benefits and clarifies expectations at each stage.
Steps to File the Claim
Initiating a workers’ compensation claim requires specific actions from the injured employee. The speed and accuracy of these steps directly affect how quickly the process advances.
Notification
The first critical step is notifying your employer about the work-related injury or illness. Most systems require prompt reporting, often within a specific timeframe ranging from a few days to several weeks from the injury date or when you recognized the condition was work-related. Reporting the injury to a supervisor or designated contact immediately starts the claim process. Delaying this notification pushes back subsequent steps and, in some cases, failing to report within the legally required period can jeopardize eligibility for benefits.
Submission of Forms
After notifying the employer, the claim must be formally documented, typically using a specific form often called a “First Report of Injury” or similar title. The employer usually provides this form, and the employee must complete it accurately, detailing the incident, injury, and any witnesses. Prompt and correct completion is essential, as errors or omissions can cause delays while the employer or insurer seeks clarification. The completed form is then returned to the employer.
Deadlines
Beyond notifying the employer, strict deadlines, known as statutes of limitations, govern the formal filing of the claim form with the state workers’ compensation agency or the insurance carrier. These deadlines are distinct from the initial employer notification requirement and are generally longer, often one to three years from the injury date or the date the condition was recognized as work-related. For occupational diseases, the deadline might start from the date of disability or last exposure. Missing this filing deadline typically prevents the claim from proceeding, regardless of its merit. Adherence to these deadlines is essential for the claim to be considered.
Timelines for Insurance Review
Once the claim form is received, the employer’s insurance carrier begins the review process. This phase involves investigating the reported injury or illness to determine if it is compensable under workers’ compensation laws—specifically, whether the injury arose out of and in the course of employment.
The investigation may include reviewing the claim form, obtaining medical records, interviewing the employee and employer, and contacting witnesses. The complexity of the injury and the clarity of its connection to work activities influence the investigation’s duration.
Workers’ compensation systems typically set deadlines for insurers to complete this review and decide whether to accept or deny the claim, commonly ranging from 14 to 90 days after receiving notice. Insurers might request extensions in complex cases. Within this period, the insurer must formally notify the employee in writing of their decision, explaining the reasons if the claim is denied. This decision marks a transition toward benefit payments if accepted, or potential dispute resolution if denied.
Payment and Benefit Disbursements
If a workers’ compensation claim is accepted, benefits are disbursed according to specific rules and schedules. Coverage for reasonable and necessary medical treatment related to the injury often begins shortly after the injury occurs, sometimes even before formal claim acceptance. Insurers are typically required to authorize necessary care promptly, and medical bills are sent directly from providers to the insurer for payment within a set timeframe, such as 30 or 45 days.
Wage replacement benefits, often called temporary disability payments, involve a waiting period, usually three to seven days immediately after the disability begins. Compensation generally starts accruing the day after this waiting period ends. The first payment is typically issued within a specific timeframe after the claim is accepted and the waiting period is met, often within 14 to 21 days from when the employer was notified or the claim was approved.
Subsequent wage replacement payments are usually made regularly, such as weekly or bi-weekly, mirroring normal pay schedules. These payments continue as long as the employee is medically certified as unable to work due to the injury. If the disability lasts beyond a certain duration (e.g., 14 or 21 days), many systems require retroactive payment for the initial waiting period, ensuring the employee is eventually compensated for those first few days missed.
Resolving Disputes
When an insurer denies a claim or disputes arise over treatment or disability extent, the path to receiving benefits involves dispute resolution processes, which add time.
An initial step might be informal resolution, such as asking the insurer to reconsider based on new information or participating in mediation. Mediation involves a neutral third party facilitating discussions to reach an agreement. While potentially faster than formal litigation, mediation is not always successful.
If informal methods fail, the next stage is often a formal administrative hearing before a workers’ compensation judge or hearing officer. Filing for a hearing and waiting for it to be scheduled can take several months. During the hearing, both sides present evidence. The judge then issues a written decision, typically within 15 to 90 days after the hearing concludes.
If either party disagrees with the hearing decision, they generally have the right to appeal, first to a workers’ compensation appeals board or commission. Filing deadlines are strict, often 20 or 30 days from the decision date. The board reviews the case record and written arguments, which takes additional time, potentially several months, before issuing its decision.
In many systems, further appeals to state courts may be possible if a party remains unsatisfied after the administrative appeal. Each level of review adds substantial time, potentially months or years, making the resolution of contested claims a lengthy process compared to straightforward, accepted ones.
