We get many questions about what happens if an employee files workers’ compensation. When an employee suffers a work-related injury or occupational illness, Oklahoma law provides a system to help injured workers obtain medical treatment and wage-replacement benefits. For employers in Oklahoma County, receiving notice that an employee has filed a workers’ compensation claim can be concerning, especially if the business has never dealt with the process before. Understanding what happens after a claim is filed can help employers and employees navigate the system more effectively and avoid costly mistakes.
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The Claim Usually Begins With a Workplace Injury
Most workers’ compensation claims begin when an employee reports an injury that occurred while performing job-related duties. Common claims involve falls, lifting injuries, repetitive motion injuries, machinery accidents, vehicle accidents occurring during work, and occupational illnesses that develop over time.
After the injury is reported, the employer and its workers’ compensation insurance carrier typically begin investigating the claim. The insurance company may review medical records, accident reports, witness statements, and other information to determine whether the injury is compensable under Oklahoma law.
The employee should report the injury promptly, as delays in reporting can create disputes over the validity of the claim.
Medical Treatment Often Becomes the Immediate Focus
One of the first issues addressed in most workers’ compensation cases is medical treatment. If the injury is accepted as work-related, the employer’s workers’ compensation insurance carrier is generally responsible for paying authorized medical expenses related to the injury.
These expenses may include physician visits, hospital treatment, surgery, physical therapy, prescription medications, diagnostic testing, and follow-up care. In many cases, disputes arise regarding the extent of treatment needed, whether a procedure is necessary, or whether the injury is actually related to the workplace accident.
Medical records often become one of the most important pieces of evidence throughout the claim.
The Employee May Receive Temporary Disability Benefits
If the injury prevents the employee from working, the employee may qualify for temporary disability benefits. These benefits are intended to provide partial wage replacement while the employee recovers and remains unable to return to work.
The amount and duration of benefits depend on several factors, including the employee’s average weekly wage, medical restrictions, and the severity of the injury. Benefits generally continue until the employee returns to work or reaches maximum medical improvement.
Employers often monitor medical reports closely because work restrictions and return-to-work recommendations can significantly affect the duration of benefits.
The Insurance Company May Investigate the Claim
After an employee files a workers’ compensation claim, the workers’ compensation insurance carrier frequently conducts an investigation. The insurance company may interview witnesses, review accident reports, obtain surveillance footage, examine employment records, and request medical evaluations.
Not every claim is automatically approved. The insurer may challenge whether the injury occurred at work, whether the injury is as serious as claimed, or whether a pre-existing medical condition is responsible for some or all of the employee’s symptoms.
Disputes regarding compensability are common and may ultimately require resolution through the workers’ compensation court system.
Some Claims Result in Permanent Disability Awards
Once medical treatment is complete, some employees may receive a permanent impairment rating if the injury results in lasting physical limitations. Depending on the severity of the impairment, the employee may be entitled to additional compensation beyond temporary disability benefits.
Permanent disability claims often involve medical experts, independent medical examinations, and disputes regarding the extent of the employee’s impairment. Because these determinations can significantly affect the value of the claim, they are frequently contested.
Retaliation Claims Can Create Additional Liability
One of the most important things employers should understand is that Oklahoma law generally prohibits retaliating against an employee for pursuing a valid workers’ compensation claim.
Employers should exercise caution before disciplining, terminating, or otherwise taking adverse action against an employee who has filed a claim. Even when legitimate business reasons exist for employment decisions, the timing and circumstances may become important if a retaliation allegation arises.
Careful documentation and legal guidance are often critical when employment decisions involve an injured worker.
Settlement Is Often Possible
Many workers’ compensation claims eventually resolve through settlement negotiations. A settlement may provide a lump-sum payment that resolves some or all of the issues in dispute. Settlement discussions often occur after the employee’s medical condition stabilizes and the parties have a clearer understanding of the long-term effects of the injury.
Not every case settles, however. Some disputes proceed to hearings where administrative judges determine issues involving compensability, disability ratings, medical treatment, and benefits.
OKC Workers Compensation Attorneys
When an employee files a workers’ compensation claim, it can affect both employees and employers in significant ways. Questions involving medical treatment, disability benefits, return-to-work issues, insurance coverage, and settlement value often become complex very quickly. Because every workers’ compensation case presents unique facts and legal issues, individuals and businesses facing these situations should seek experienced legal guidance as soon as possible. Contact an Oklahoma City workers compensation attorney that you can count on. For a free consultation with the Kania Law – OKC Attorneys, call 405.367-8710. Or you can follow this link to ask a free online legal question
