If my claim was accepted
- I was injured at work
- How to file a claim
- If my claim was accepted
- If my claim was denied
- How I return to work
- How my case is resolved
You should hear whether your claim is accepted or denied from your employer or its claims administrator within 90 days from the date the claim form is given to your employer. If you do not, your injury will be presumed to be covered.
What benefits am I entitled to?
Workers' compensation insurance provides five basic benefits:
- Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
- Temporary disability (TD) benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering
- Permanent disability (PD) benefits: Payments if you don't recover completely
- Supplemental job displacement (SJDB) benefits: (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don't recover completely and don't return to work for your employer
- Death benefits: Payments to the spouse, children or other dependents if a worker dies from a job injury or illness.
What if I have a disagreement about my benefits?
At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury. When there is a disagreement, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers' compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).
Want to learn more? Find it in the guidebook
- Chapter 3: Medical Care
- Chapter 5: Temporary Disability Benefits
- Chapter 7: Permanent Disability Benefits
- Chapter 8: Supplemental Job Displacement Benefits
- Want a complete version of the injured worker guidebook?
Did you know?
- You can contact the Information and Assistance Unit if you have questions or call the DWC Information Services Center at 1-800-736-7401 to speak to a live representative.
- The claims administrator must keep you up to date by sending letters that explain:
- How TD payment amounts were determined.
- Reasons for any delay in TD payments.
- Reasons for changes in TD payment amounts.
- Why TD benefits are ending.
Questions workers have:
- How do I find out what's going on with my case?
- How much will I receive in temporary disability payments?
- Who decides what type of work I can do while recovering?