How Long Do I Have to Make a Workers' Comp Claim?

Work-related injuries are an everyday occurrence. Many workplace accidents are minor and do not require the injured employee to miss any time from work. But with more substantial workplace injuries, the employee has a legal right to seek workers’ compensation benefits.

Workers’ comp provides medical expenses and wage replacement benefits until the injured worker can return to employment. However, there are time limits and eligibility requirements to file for workers’ comp benefits. The workers’ compensation process varies by state, so you should talk to a local workers’ comp lawyer about the filing process in your state.

Filing a Workers’ Compensation Claim

Workers’ compensation is a state-supervised insurance system designed to provide “no-fault” benefits to workers injured on the job or for occupational illnesses. No-fault means the employee does not have to prove that the employer’s negligence caused the job-related injury. However, the employer is only required to pay workers’ compensation benefits when timely informed of the accident.

Each state has its own workers’ compensation filing process, with notice requirements, filing deadlines, and statutes of limitations. There is a time limit to give your employer the first report of injury to make sure you get compensation for your medical care. For a workers’ comp claim in your state, talk to a local workers’ comp lawyer about the process.

Injured workers have to notify their employer within a certain time period from the date of the injury. The notice requirement varies by state.

For example, in New Mexico, an employee has 15 days from the date of injury to give “notice in writing” to their employer if they have suffered an injury on the job and need medical attention. If the employee is unable to give notice by reason of injury or some other cause beyond their control, the deadline can be extended up to 60 days. But written notice is not required at all if the employer or the employee’s supervisor has “actual knowledge” of the employee’s accident.

In Alabama, you should notify your employer that you were hurt on the job within five days, and they should recommend that you seek medical treatment.

According to Christopher Elmore, a workers’ compensation attorney at Elmore Law Firm in Albuquerque, the deadlines are not always so simple. The state may grant a 60-day timeframe if the employer did not post the proper workers’ compensation claim forms and notices in the workplace. Elmore says situations have also occurred in which the deadline is further extended beyond 60 days after the injury.

“The time to give notice is from when the worker knew or should have known that they had a compensable accident,” Elmore says. For example, if the worker didn’t immediately realize that they were hurt or didn’t realize that an infection had set in. “It’s a little bit of a grey area, but 60 days is supposed to be the ultimate cap.”

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Who Selects an Injured Worker’s Doctor?

An employer generally reports the incident to its workers’ compensation insurance carrier after notification of a workplace accident. The choice of a doctor to treat your work-related injury depends on state law. Some states allow the worker to choose, and other states allow the employer to select the doctor.

For example, in New Mexico, your employer then has the right to select a doctor to treat your injuries or to allow you to select your own doctor at this stage. “Whoever picks (the healthcare provider) first is basically stuck with that choice, and then after 60 days the other party gets to switch care for the remainder of the claim,” Elmore says.

If an employer fails to provide a written notice regarding the direction of the employee’s care, and the employee begins seeing a provider who accepts workers’ compensation, neither party is considered to have selected the provider. At this point, Elmore says, “the employer can send the notice, and the 60-day window will begin.”

In cases where the employer elects to make the initial selection, the employee has the right, under New Mexico workers’ compensation law, to request a change after 60 days of treatment. Similarly, if you select your doctor initially, the employer may demand a change after 60 days. You can only do this once, whether by the employer or the employee. Any further changes in the employee’s treating doctor must be made by mutual agreement or an order from a workers’ compensation judge.

What Happens When an Employer Denies a Workers’ Compensation Claim?

The employer or insurer ultimately decides whether to pay workers’ compensation benefits. The amount of the monthly benefit and its start date depend on state law. Most states provide a wage replacement benefit of about two-thirds of the worker’s average weekly earnings.

In New Mexico, if the injured employee is unable to return to work for more than seven days, “temporary total disability benefits” of up to two-thirds of the employer’s prior weekly wages are payable starting on the eighth day. These benefits continue until the employee is able to return to work at their pre-injury wage, or a doctor certifies the employee has attained “maximum medical improvement (MMI).”

If an employer or insurer denies or ends workers’ comp benefits, the employee has the right to challenge that decision. “The employer or insurer in good faith, most of the time, will accept the claim initially, and then they will perform an investigation,” Elmore says. However, he estimates employers deny claims on the grounds of causation. This means, “the story doesn’t add up as to how the worker was injured, or there are subsequent witnesses who say no, that didn’t happen.” Another ground for ending benefits is if the employee is failing to actually seek treatment for the injury.

Challenging the denial requires filing a formal complaint with the state workers’ compensation administration. The state agency will first attempt to mediate the dispute between the employee and employer. If that is unsuccessful, a formal hearing will be held before a workers’ compensation judge. Should the judge rule for the employer, the employee can appeal an adverse decision through the court system.

Statute of Limitations and the Appeals Process

Reporting a job-related injury or an occupational disease to an employer is not the same thing as filing for workers’ compensation benefits.

Beyond notifying your business or organization that an accident has occurred in the workplace, you still need to file for workers’ comp. Alabama workers’ compensation law has a two-year statute of limitations or timeframe for claims.

Unfortunately, some people struggle to get their workers’ compensation claim paid. If your workers’ compensation benefits were denied by an insurance carrier, you have the right to file an appeal in Alabama. Unlike the majority of U.S. jurisdictions, Alabama does not have an administrative law system for workers’ comp appeals.

In effect, this means an injured worker must appeal the denial of benefits by filing a civil lawsuit in the appropriate Alabama circuit court. 

Find Legal Help

If your employer denies your claim or denies your medical benefits for workplace injuries, an experienced workers’ comp attorney can help. Get legal advice about your state’s workers’ compensation act from a local attorney.

An experienced workers’ compensation lawyer can help you with your workers’ compensation claim.