Workers’ Compensation Claim Limitations and Deadlines | Expertise.com (2024)

Based on the 2021 findings of the US Bureau of Labor Statistics, over 4.2 million medically consulted injuries and illnesses were reported by employers in both the public and private sectors. It also found that for every 100 full-time workers, there are 3.4 compensation claims filed on an annual basis.

To address these claims, the Office of Workers’ Compensation Programs (OWCP) continues to promote various initiatives that provide energy and federal employees, as well as coal mine, longshore, and harbor workers, with medical care, wage replacement, and vocational rehabilitation. The main goal of these benefits is to make it easier for workers to pay their bills after getting hurt or sick at work.

Another way to help workers is through the Claims Administration program of the Federal Employees’ Compensation Act (FECA), which is administered by the Division of Federal Employees', Longshore and Harbor Workers' Compensation. The program, funded by employing agencies, works efficiently to settle injury and death claims. It also ensures that workers' compensation and medical bills are paid on time and helps injured workers who want to return to work.

These programs encourage workers to seek out the benefits they are entitled to in case they are injured or become sick on the job. Several regulations and guidelines under the FECA detail the requirements and limitations involved as they prepare to file a workers’ compensation claim.

What Is the Statute of Limitations for Federal Workers’ Compensation Claims?

According to the FECA, workers have a maximum of three years to file a compensation claim starting from the date of their injury. This timeframe applies to both minor and traumatic injuries. When deciding, the OWCP's district offices look at how quickly claims were filed.

When to Notify Your Employer of a Workplace Injury

Workers are required to report any workplace-related injuries to their immediate superiors as soon as possible. Afterward, their superiors must report the incident to the Secretary of Labor. They must also alert the Occupational Safety and Health Administration (OSHA) of the following:

• Any fatalities within eight hours

• Any instances of hospitalization, amputation, or loss of an eye within 24 hours

Workers must submit to their supervisor a notice using Form CA-1 within 30 days from the date of the injury. This is so they can receive continuation of pay (COP) after sustaining a disabling traumatic injury. An employer can stop a worker's COP if they don't send medical proof of an injury-related disability within 10 work days.

If a workplace-related illness or disease causes an injury, a written notice must be filed using Form CA-2 within the same 30-day deadline. Workers can get Forms CA-1 and CA-2 from their employing agency or the OWCP.

Can I Reopen My Claim if My Workplace Injury Gets Worse?

You can reopen a settled compensation claim if a work injury worsens over time. However, you can only do so if physical or mental changes stem from it. The condition must also have been caused directly by the original injury, not by complications.

If you reopen a claim due to a worsening condition, you must prove that:

• The deterioration of your condition is directly linked to your original compensable injury

• Your condition requires you to obtain additional medical care as a result

To prove these factors, you can seek the opinion of a medical professional who will document and corroborate your condition. An administrative law judge will then decide at a hearing whether to reopen your case based on your statement and any medical reports presented at a hearing.

You must file a request to reopen your case within a specific time period, which varies from state to state in some cases. In general, the statute of limitations for such a request is either within six years from the date of the injury or within two years from the last compensation payment. The same timeframe also applies when seeking to reopen a claim for medical benefits.

In most cases, a claim cannot be reopened if a worker accepts a lump-sum settlement from an insurance company. However, exceptions can apply if there is evidence of fraud or a legal mistake involving a material fact. The statute of limitations may also be paused if an insurer fails to provide a worker with any information that it is legally obligated to share.

Exceptions to the Statute of Limitations for Workers’ Compensation Claims

There are exceptions to the federal statute of limitations, both in terms of when it begins running and when a worker can file a claim past its three-year timeframe.

Regarding Discovered Conditions or Disabilities

If a worker's compensable disability isn't discovered for a reasonable amount of time, the statute of limitations won't begin to run until it is discovered. According to the principle of reasonable diligence, it can also start when a worker should have been aware of the disability or a connection between a latent condition and their employment.

Regarding an Immediate Superior’s Knowledge of an Injury or Death

Workers and related parties may also be able to get paid for injuries or deaths that happened more than three years ago if the worker's immediate supervisor was told in writing about the injury or death within 30 days of it happening.

The same exception is made if a worker's immediate boss knows about an injury or death on the job within 30 days of it happening, and that knowledge is enough to make the boss reasonably aware.

If a written notice is to be submitted, it must contain the following:

• The worker’s name

• The worker’s address

• The exact locality where the injury took place

• The year, month, day, and hour when the injury took place

• The injury’s nature and cause

• Any employment factors that may have contributed to a worker’s death (if the notice involves such)

The notice must also contain the signature and address of the individual submitting it, whether it is a worker or any other person acting on their behalf. If the individual doesn’t provide notice to an immediate superior due to exceptional circ*mstances, the Secretary of Labor can excuse their failure to comply, and the statute of limitations will not run against them.

Regarding Minors and Those Deemed Legally Incompetent

If a claim for workers' compensation involves a minor or a person who is deemed incompetent because of an injury or disability, the federal statute of limitations doesn't start until the minor turns 21 or the incompetent person gets better. The statute may also begin when the person is provided a legal representative to speak for them.

When to Talk to a Workers’ Comp Attorney

Workers are advised to consult with a workers’ compensation attorney who can help them mitigate potential complications and submit any requirements involved in their claim. An attorney can also provide them with information concerning the possible benefits they can get from their claim and any limitations that fall under federal and state laws.

In terms of specific scenarios, legal aid can be sought if:

• An employer or insurer denies a claim or the validity of an injury

• An employer does not have workers’ compensation insurance

• An employer suspends, terminates, or retaliates in any other way against a worker for reporting an injury or filing a claim

• A worker seeks to negotiate a maximized settlement with an insurance company

• A worker wishes to apply for Social Security disability benefits

• A worker is unable to work normally or return to their workplace due to injury-related disabilities

• A worker’s injury is caused by an employer’s misconduct or a third party

• An issue in a claim results in a workers’ compensation hearing

An attorney is often unnecessary if a worker sustains only a minor injury, does not have a pre-existing condition that can complicate such an injury, or misses little to no work due to their injury. However, workers are still advised to have their cases evaluated by an attorney to help them plan their claims.

Legal Resources for Injured Workers

National Employment Law Project - State Directory

The National Employment Law Project (NELP) is a nonprofit organization that advocates for advancing workers’ rights and launches capacity-building initiatives nationwide. NELP’s website has a directory that links to the websites of state agencies and commissions overseeing compensation claims processing. The directory also has links to legal resources that people can use to learn about how workers' compensation laws work in their states.

American Bar Association - Pro Bono Labor and Employment Law Resources

The website of the American Bar Association provides both civilians and attorneys with access to legal resources concerning labor and employment laws and guidelines. Some resources also lead to the websites of the Equal Employment Opportunity Commission, the National Institute for Occupational Safety and Health, and OSHA, all of which have information about workers' compensation laws, processes, and rules.

Workplace Fairness

Workplace Fairness, which used to be called the National Employment Rights Institute, is another non-profit that teaches workers nationwide about their rights to benefits and pay by providing them with helpful online resources. Its website also has sections that explain how to take legal action and file claims against state and federal agencies, including what steps to take and what problems you might face. Additionally, it can help workers find local attorneys who can assist them with employment law cases, ranging from workers’ compensation and whistleblower retaliation to Social Security disability and wrongful termination.