How Long Does It Take to Get a Response for a Work Comp Claim?
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As a writer and research for over two decades, Tom Senkus shares his expertise on such topics as financial planning, insurance, telecommunications, and more. His work has been featured in over 150 publications.
Reviewed by
Paul Martin is the Director of Education and Development for Myron Steves, one of the largest, most respected insurance wholesalers in the southern U.S.
If you've filed a workers' compensation claim after suffering a work-related injury or illness, one of the most stressful times can be waiting for a decision on your claim. One way to ease your mind is to understand the basics of the workers’ comp claims process and the timelines in your state. Some states set strict deadlines for claims processing, while others have looser guidelines that ultimately determine how long it will take to get a definitive answer.
Table of Contents
In this article, we’ll explore how long it takes for a workers' comp claim to be processed, answering such questions as:
How long will it take for my workers’ comp claim to be approved or denied?
What should I do if I don’t receive a response about my claim?
What types of benefits can I receive?
What can I do if my claim is rejected?
For the most peace of mind, consult an independent insurance agent about your workers' comp claim. They can answer your questions and inform you of the particulars in your state. Whether you need to know about how many benefits you’re entitled to, typical situations similar to yours, or other forms of similar disability coverage, contact an independent agent today.
How long will it take for my workers’ comp claim to be approved or denied?
After you’ve submitted your workers’ comp claim, you will receive written notice that your claim was approved or denied within a few weeks. Because workers' compensation programs are run by each state, state law ultimately determines the time frame of claims processing. As a general rule, you can expect a response within 2 or 3 weeks after you’ve given notice of an injury or filed a claim.
Texas requires that insurers deny a claim or begin to pay benefits to an injured worker within 15 days after receiving written notice. Pennsylvania, in contrast, sets 21 days after as a deadline.
What should I do if I don’t receive a response about my claim?
If you have not heard from the insurer or received documentation in the mail, you should contact your insurance adjuster or claims administrator directly. If this does not provide adequate information regarding your workers' comp claim, contact your state’s workers’ compensation agency, a workers’ comp lawyer, or an independent insurance agent to get a clearer picture of the status of your claim.
Many states also offer online portals where you can check your claim’s status, such as Oregon’s Workers’ Compensation Board Portal.
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How long will the workers' comp claim investigation take?
In every state, injured workers must report their injury or work-related illness to their employer within certain time limits to receive workers’ comp benefits. Also, some states require the injured worker to file a claim with the state’s workers' compensation agency before benefits can begin. Bear in mind that if you don’t follow the correct procedure, you may be ineligible to receive some or even all of your benefits.
That being said, once the claim is initiated, the insurer or party responsible for determining your claim will begin an investigation. A claims administrator will usually speak to you and your employer about the claim, and review relevant medical records, accident reports, and other documents related to your claim.
This process begins a countdown where the investigating party must come to a decision within a reasonable period. If you don’t receive an answer about your claim within the deadline, some states will consider your claim to be accepted and you’ll begin to receive benefits. Other states will require the insurance company to pay a financial penalty or provide benefits if they fail to make a decision about your claim or request additional time within the deadline.
To give you an idea of how some states work, let’s look at some examples:
- California requires the insurer to reject a workers’ comp claim within 90 days after the employer first learned about the injury; otherwise, it’s presumed that the claim is approved. However, if new evidence is discovered after the end of this period, the insurer may be able to deny the claim.
- Florida requires insurers to respond to a petition for workers' comp benefits within 14 days after receiving it. Or,the insurer has the option to pay benefits while it investigates. If the insurer chooses to pay benefits while they conduct further investigation, the petition will be considered accepted if the insurer doesn’t give a final answer within 120 days after it starts paying benefits, unless there’s new evidence regarding the claim.
It’s important to cooperate with the insurance company's reasonable requests for information and documents during this process to the best of your ability. However, if you have any concerns about the claims investigation, you may want to contact a workers’ comp lawyer to be sure that you don’t jeopardize your case and that you’re being treated fairly. Speaking with a lawyer is a smart decision if the insurer has not returned your phone calls or you believe you are under surveillance.
To find out more about your state’s rules for responding to claims, contact an independent insurance agent to guide you through the complexity of the claims process and rules regarding each state’s workers’ compensation process.
What types of benefits can I receive?
Essentially, the severity of your injury determines the extent to which you’ll receive appropriate benefits in:
- A lump-sum payment
- Weekly payments
- Or less commonly, a structured settlement
After an injury, one of the following four classifications of workers’ comp benefits will be offered to an injured individual:
- Temporary total disability benefits (TTD)
- Temporary partial disability benefits (TPD)
- Permanent partial disability benefits (PPD)
- Permanent total disability benefits (PTD)
| Temporary Partial Disability (TPD) | Injuries that fall under this category typically reward workers who can maintain some capacity for employment. TPD basically compensates workers for the difference between their previous wages and their current reduced wages. |
| Temporary Total Disability (TTD) | Injuries that are designated as TTD, which prevents a worker from performing any work duties, can expect to receive two-thirds of their income while they recover. However, many states offer benefits up to a certain cap or time. After this period elapses, benefits may end until further medical examinations are performed on the injured party to determine their current and expected disability status. |
| Permanent Partial Disability (PPD) | Serious injuries that cause an injured worker to permanently lose the use of their body will be covered under permanent partial disability. This designation is for workers who can only do a limited amount of work after their injury. Depending on the state where they are employed or reside, the maximum amount they can expect to receive can vary depending on various factors, such as future employability, available vocational training, and more. |
| Permanent Total Disability (PTD) | If an injury is such that it prevents a worker from working at all in the future, they may be able to get two-thirds of their weekly earnings for the rest of their life, or three-quarters if they have dependents. |
State-Specific Benefits
In general, most injured employees can receive the following kinds of benefits via a workers’ compensation claim in most states:
- Compensation for lost wages
- Payment of medical bills and services related to the injury/illness
- Permanent impairment benefits
- Vocational rehabilitation
- Death benefits
Of course, having the proper preventive precautions in place beforehand to protect your finances and your family is always a wise decision. By speaking with an independent insurance agent before an injury occurs or illness develops, you can get a clearer picture of your options. Some of these options include:
- Annuities
- Life insurance
- Long-term care (LTC) insurance
- Disability insurance
- Investments, such as mutual funds
- And more
Benefits of an Independent Insurance Agent
Independent insurance agents have access to multiple insurance companies, ultimately finding you the best coverage, accessibility and competitive pricing while working for you. Find an independent insurance agent in your community here.
https://www.nolo.com/legal-encyclopedia/how-long-does-workers-compensation-take-to-be-approved.html
https://www.lawyers.com/legal-info/workers-compensation/how-long-will-it-take-for-my-workers-comp-claim-to-get-approved-or-denied.html