How Long Can A Workers Comp Claim Stay Open – As an employer, you know that workers’ compensation exists to protect you and your employees. You, from unwanted lawsuits, and your employees, from financial challenges following a work-related injury.
After that, however, the rules and regulations put in place for workers’ compensation claims can get pretty complicated—and you may have some questions. For example, if you’ve ever wondered if there are time limits on workers’ comp claims, read on as we break down this common question and look at the factors that affect how long your employee claim can stay open .
How Long Can A Workers Comp Claim Stay Open
Workers comp claims have been paid is the first step in learning how long a claim can remain open. There are two main ways workers’ comp settlements are handled:
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There is also the possibility of a judicial decision in a workers’ compensation case if participants cannot reach one of the two types of settlements listed above.
Simple workers’ comp claims may remain open for several weeks, while more complex claims that require ongoing medical treatment may remain open anywhere from one to several years. If a worker has an injury that leaves them with a long-term disability that requires regular medical care, their claim may remain open for life.
As you might guess, the type of settlement you reach on a workers’ comp claim affects the length of time the case stays open.
If the workplace injury has stabilized and the employee has completed medical care and is able to return to work, a compromise and release may be a good option.
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If that’s the case, the workers’ comp case will only be open long enough for the participants to agree on the sum and the employee to receive the check. At that point, the case will be closed. This usually takes a relatively short time, and the case can be resolved within a few weeks.
For more complex cases, where ongoing medical treatment is required and the employee suffers a temporary or permanent disability, a stipulation and settlement award sometimes makes more sense.
Often, settlement will be delayed while the worker is still recovering, because it is unclear how much the insurer will have to pay for medical expenses. The insurer, however, is required in many states to pay for medical expenses while the settlement is still pending. In California, for example, the insurer must provide up to $10,000 for treatment while the case is being considered by the claims administrator.
In these cases, an amicable settlement may not be reached for more than a year, and workers’ compensation benefits may continue for years, providing financial support for the employee while they cope. to a personal injury with lasting effects.
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If that happens, the insurer may pay for medical expenses after the date of injury. There is no statute of limitations on claims; in some cases, workers’ compensation coverage may end or decrease when the worker reaches age 65 and Medicare begins. In other cases, it may last as long as the employee lives. The terms of the settlement will dictate the length of time the claim is paid.
Workers’ compensation insurance is governed in part by rules created by the Division of Workers’ Compensation in the state where the business operates. So the answer to a question like “How long can you be on workers’ comp in Texas?” may be different from “How long can I be with Ohio workers comp?”
In general, state laws regarding workers’ comp deadlines are more often concerned with the length of time the employee has to file the claim—not the length of time they can receive benefits.
If a worker needs care for the rest of their life, their claim can stay open for their lifetime—and that doesn’t vary much from state to state. It is possible that payments may be reduced once the employee begins collecting social security retirement benefits, but there is no age limit for workers’ compensation.
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If you or your employee is concerned about possible state laws limiting benefits, your best bet is to consult with the law firm of a workers’ compensation attorney. These legal professionals understand the labor code in your state and can discuss the potential length of an injury claim.
If you’re using a payroll or workers’ comp system like this easy-to-use app, you can be sure your state laws are being considered. This ensures that you are not paying too much or too little on your premiums and that you stay compliant and avoid future headaches.
Another question you or your employees may have is whether a work injury claim remains open if the employee leaves the business to work elsewhere. The answer is yes, if an injured worker leaves the business to work elsewhere and is still seeking treatment for the injuries they sustained at their former employer, the claim will remain open.
A workers’ comp settlement is when an employee, employer and insurance company agree on an amount of money to be paid for a workplace injury (and the money is paid), whereas a lawsuit is when they disagree and someone sues, where the case goes to court.
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At a lawsuit or hearing, the parties to the claim, including the employee, their workers’ compensation attorney, if they have one, and a representative from the insurance company go before a judge who has experience dealing with the law. in workers’ compensation.
The judge will hear testimony in the case, review medical records and previous settlement attempts, and decide the claim and how much money to award the claimant—or, conversely, rule that the claimant is not entitled to in payment.
An injured employee can ask a judge to settle the case if the claim is denied and they want to appeal it or if the amount the insurer wants to pay seems insufficient. They may need to undergo a medical examination from an independent medical provider, and they may want to obtain legal advice and retain an attorney if they have not done so before.
Although a case can remain open as long as the injured worker is alive, there are deadlines, mostly imposed by the state, for filing a claim. Let’s take California, for example. In California, they include the following:
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Other states may have different regulations and deadlines. If you are unsure of the regulations or deadlines in your state, talk to your insurance agent.
The first and possibly most important question a claims adjuster will ask an employee is: “What happened?” If you are the person who was injured and you are not sure how exactly the accident happened, it is a good idea to talk to eyewitnesses so that you can answer this question accurately.
The injured worker should not embellish, exaggerate, or lie, as this will raise red flags that could affect the adjuster’s final report. The adjuster can take the time to talk to others on the scene, and note any discrepancies between what they say and the worker’s own account.
If you are the business owner, the adjuster will want to ask for your version of the accident or injury. They may also want to talk to you about the safety conditions in your place of business, as well as the protocols in place to protect your employees from potential accidents. This is one reason why it is a good idea for business owners to comply with all OSHA safety requirements and state-mandated safety regulations before an accident occurs.
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Here are some more tips to make that meeting go as smoothly as possible, and to handle common questions the adjuster may have.
You don’t need to be a workers’ compensation expert to be a business owner—but some basic knowledge about what happens when an employee is injured in a work accident can help. If that happens, you will be involved in helping them settle their claim in a way that is fair for all involved.
Now that you know a little more about how claims work, the types of settlements offered, and how long a claim stays open, you can answer questions your employee may have about the process and how it will develop .After sustaining an injury at work, you may have questions about how to file a claim or what benefits you are entitled to receive. We understand that navigating your possible benefit options can be confusing and can add additional stress to your situation. Many of our clients have asked about the specific differences between workers’ compensation benefits and SSDI. Knowing the differences can help you understand what is right for you after sustaining an injury. An attorney can help answer questions about your case and help get you the compensation you deserve.
Are you receiving workers’ compensation benefits? Are you worried about how your workers’ compensation will affect your Social Security benefits? Fortunately, employees can usually receive both workers’ compensation and Social Security benefits.
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However, you may not receive every one of them
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