Checklist · Labor and Employment

Filing and Pursuing a Workers Compensation Claim: A Practical Checklist

42 U.S.C. § 12112

Type
Checklist
Jurisdiction
National
Date
2026-07-26
Topic
Labor and Employment

This checklist runs a workers compensation claim from the hour of the injury through settlement, in ten phases. Phases 1 through 3 cover the first day, the first medical visit, and written notice, which together determine more of the outcome than anything that follows. Phases 4 and 5 cover the claim filing, the treating-physician question, and the wage benefit audit. Phases 6 through 8 cover a denial, the hearing, the independent medical examination, and light-duty offers. Phase 9 covers the third-party claim, liens, and offsets. Phase 10 covers settlement review and the employer's parallel obligations. Model letters, a deadline table, a division of responsibility, and a ranked failure-mode list are included.

Filing and Pursuing a Workers Compensation Claim: A Practical Checklist

Labor and Employment > Workers Compensation | Published 26 July 2026 - Updated 10 August 2026 | UpLaw - uplaw.us

Read Phase 2 before you go to the doctor. Almost every avoidable loss in this area traces to a sentence written in an intake note during the first hour.

The narrative is Hurt at Work: How a Workers Compensation Claim Actually Moves. The doctrine is Workers Compensation Claims: A Comprehensive Guide to Notice, Benefits, Disputes, and Settlement. The forms are in The Workers Compensation Claim Toolkit.

Phase 1 — The first hour

☐ Stop working. Continuing the shift is the single most common act that undermines a claim, because it becomes the carrier's argument that the injury was not serious and did not happen the way you say.

☐ Tell a supervisor now. By name. Note the time.

☐ Write down, in your phone, before you do anything else:

  • The date and the clock time
  • Exactly what you were doing — the object, the weight, the height, the motion
  • What you felt and where
  • Who was present
  • What the supervisor said

☐ Photograph the scene. The pallet, the spill, the ladder, the machine, the guard that was missing. Do it before anyone cleans it up, which will happen within the hour.

☐ Photograph any visible injury.

☐ Identify equipment by owner. If a machine, vehicle, tool, or chemical was involved, photograph the manufacturer's plate, model, and serial number. This is the beginning of a third-party claim that is often worth more than the compensation case.

☐ Note whether anyone from another company was present. Another contractor, a delivery driver, a temp agency worker.

☐ Ask for the incident report and ask for a copy. If told there is none, note that.

☐ Do not sign a statement you have not read. Do not sign one that describes the injury in words you would not use.

Phase 2 — The first medical visit

☐ Say it happened at work, in the first sentence.

☐ Give the mechanism in one specific sentence. Not "my back hurts." Rather: "Tuesday, March 4, at work, lifting a 40-pound case off a pallet at shoulder height, I twisted and felt a sharp pain in my lower back that went down my right leg."

☐ List every body part that hurts, including the ones that hurt less. A shoulder omitted on day one is a shoulder contested on day three hundred.

☐ Do not minimize. "It's probably nothing" becomes an exhibit.

☐ Do not guess at a cause you are not sure of. "Maybe I slept on it wrong" is the most expensive sentence in this document.

☐ Ask what the work restrictions are, and get them in writing.

☐ Ask for a copy of the visit note before you leave.

☐ Ask who is authorized to treat you, and write down the answer.

☐ Start a treatment log — every visit, every provider, every mileage figure. Mileage to and from treatment is reimbursable in most states and claimed in almost none.

Phase 3 — Written notice, within days

☐ Send written notice even if you already told someone. Email or text to the supervisor and to HR.

Model notice

"This is written notice of a work injury. On [date] at approximately [time], while [exact task], I injured my [body parts]. I reported it to [name] on [date]. I was seen at [provider] on [date] and have work restrictions of [restrictions]. Please confirm receipt, provide the carrier's name and claim number, and identify the authorized treating providers. Please also confirm whether any leave has been designated for this absence and the date it began."

☐ Send from a personal email address, and keep a copy off company systems. Access ends on the day of separation.

☐ Confirm the notice deadline in your state. Commonly 30 days; some as short as a few days.

☐ If it is an occupational disease or repetitive injury, notice runs from a rule-supplied date — disablement, diagnosis, discovery, last exposure, or last day worked. Find out which one applies before assuming you are late.

☐ Get the claim number and the adjuster's name and direct line.

☐ Ask for the employer's first report of injury.

Phase 4 — Filing the claim

☐ Understand that notice and filing are two different deadlines. Timely notice does not preserve an untimely claim.

☐ File the claim form with the agency even where the employer says it filed one. Verify independently.

☐ Confirm the filing deadline — commonly one to three years, measured from a state-specific trigger.

☐ If benefits are being paid voluntarily, ask whether that restarts or tolls the filing clock. In many states it does, and workers rely on it without knowing.

☐ Calendar the deadline in three places. General principles: Calculating and Preserving a Limitations Deadline: A Practical Checklist.

☐ If the employer says it has no coverage, note it and stop assuming the claim is over. An uninsured employer usually loses exclusive remedy, which converts the claim into a tort suit with the old defenses abolished, and most states operate an uninsured employers fund.

☐ If you were called a contractor, do not accept it. Classification is decided by the facts. See Wage and Hour Law: A Comprehensive Guide to Minimum Wage, Overtime, Tips, and Recordkeeping.

Phase 5 — The two audits nobody runs

5A — The treating physician audit

☐ Determine which of the four models your state uses: employer directs · worker chooses · employer directs then one change · managed care assignment.

☐ If you have a right to change, find out when the window opens and closes.

☐ Exercise it early if the notes are hostile. A chart that repeats "subjective complaints out of proportion to objective findings" for five months is very difficult to overcome later.

☐ Ask the treating physician to state causation explicitly in writing — that the work event caused, aggravated, or accelerated the condition, and that the opinion is held to a reasonable degree of medical certainty. A chart without that sentence is a chart the carrier will win with.

☐ When treatment is denied by utilization review, ask the physician to resubmit with: objective findings, failed conservative care with dates, functional deficits, and the guideline criteria quoted.

5B — The average weekly wage audit

☐ Request the payroll records for the statutory lookback period. Do not accept the carrier's number.

☐ Check whether these were included:

  • ☐ Overtime, and whether regularly worked
  • ☐ Shift differentials
  • ☐ Tips and gratuities
  • ☐ Commissions
  • ☐ Production bonuses
  • ☐ A second job — many states include concurrent employment
  • ☐ Employer-provided housing, meals, or vehicle where the state counts them

☐ If you had worked less than the full lookback period, ask whether a similar employee's wages apply.

☐ If you are a minor, seasonal, or irregular-schedule worker, check the special rule.

☐ Compute the difference. An error of $150 in the AWW costs roughly $100 a week for the entire benefit period and reduces every permanent benefit derived from it. This is a twenty-minute task with a four-figure payoff.

Phase 6 — If the claim is denied

☐ Read the stated ground. It defines the case, and different grounds require entirely different responses.

Denial ground What actually answers it
Late notice Proof of actual knowledge, or absence of prejudice
Not work-related A treating physician's causation opinion in writing
Pre-existing condition Aggravation evidence: asymptomatic before, symptomatic after, specific mechanism
Idiopathic Employment-supplied hazard — height, machine, hard surface
Intoxication Rebut the presumption; metabolites are not impairment
Safety rule violation Rule not known, not enforced, or violation not willful
Independent contractor Control, integration, tools, permanence
No coverage Statutory employer up the chain; uninsured employers fund

☐ Calendar the appeal deadline immediately. These are short and unforgiving.

☐ File the claim petition or application for hearing.

☐ Do not stop treating. A gap in treatment is read as a gap in symptoms.

☐ If you cannot afford treatment during the denial, tell the provider it is a denied comp claim and ask about a lien or letter of protection. Do not let the bills go to collections silently — see Disputing a Credit Report Error and Defending a Debt Collection Suit: A Practical Checklist.

☐ Consult counsel. Claimant fees are statutory, usually capped, usually approved by the agency, and usually payable from disputed benefits. You generally cannot lose money by being represented, which is the answer to the most common reason people are not.

Phase 7 — The independent medical examination

☐ Note the appointment start time and the actual start and end of the physical examination. Write both down in the parking lot.

☐ Bring a written list: every body part, every symptom, every medication, every provider, every prior injury to the same area.

☐ Disclose prior injuries. They will be found. Disclosed, they are history. Concealed, they are impeachment.

☐ Describe a typical day — not your best day, not your worst.

☐ Do not exaggerate. Give way on strength testing only where it genuinely gives way. Effort testing is built into these examinations.

☐ Answer only what is asked.

☐ Bring someone, or record, if your state permits it.

☐ Write your own account of the examination the same day — how long it lasted, what was examined, what was said.

☐ Assume surveillance exists. Everyone carries groceries; the problem is only ever the person who said they could not.

☐ Request the IME report and read it against your notes. A report describing tests that were not performed is a report the judge should hear about.

Phase 8 — Return to work and light duty

☐ Get every offer in writing, with the job title, the tasks, the hours, the location, and the physical demands.

☐ Compare the written offer to the written restrictions, line by line.

☐ If it exceeds restrictions, do not simply refuse. Respond in writing identifying the specific conflict and asking for a corrected offer.

"Thank you for the offer of modified duty. My current restrictions are [restrictions] dated [date] from [physician]. The position as described requires [task], which exceeds [restriction]. I am able and willing to perform work within my restrictions and am asking that the offer be revised, or that the physician be asked to address the specific tasks."

☐ If the offer is within restrictions, take it. Refusal generally ends wage benefits.

☐ If it is a sham — a job invented to force a refusal, at an unreasonable distance, or on an impossible schedule — document the specifics contemporaneously.

☐ At MMI, ask what the permanent restrictions are and whether accommodation is available. This is a separate legal question under 42 U.S.C. § 12112 and 42 U.S.C. § 12111, with regulations at 29 CFR Part 1630. See Requesting Leave or a Workplace Accommodation: A Practical Checklist.

☐ Ask whether leave has been designated and when the clock started — 29 U.S.C. § 2612, 29 CFR Part 825.

☐ If you are terminated after filing, that is a separate claim outside exclusive remedy. See Responding to a Termination and Reviewing a Severance Agreement: A Practical Checklist.

Phase 9 — The third-party claim, liens, and offsets

☐ Ask the third-party screening questions, now rather than at settlement:

  • ☐ Machine, tool, vehicle, or chemical made by someone other than the employer?
  • ☐ Premises owned or controlled by someone else?
  • ☐ Another contractor's crew involved?
  • ☐ A motor vehicle involved?
  • ☐ A defective or missing guard, warning, or safety device?

☐ Preserve the physical evidence. Ask in writing that the equipment be retained and not repaired, altered, or discarded.

☐ Request the OSHA file if there was an inspection. It contains photographs, measurements, and witness statements created by someone with no stake in your claim. Background: Responding to an OSHA Inspection and Citation: A Practical Checklist.

☐ Check the tort limitations period separately. It is usually shorter than the compensation filing period and it does not care about the compensation claim.

☐ Identify every lien: compensation carrier, health plan, Medicaid, Medicare, providers, child support.

☐ Negotiate the compensation lien. Ask whether your state applies the common-fund doctrine to reduce it by a share of fees and costs.

☐ Address Social Security offset if you receive or will receive SSDI. The proration language in the settlement document controls.

☐ Address Medicare's interest in future medical if you are or will soon be a beneficiary.

Phase 10 — Settlement, and the employer's side

10A — Before you sign

☐ Understand which shape you are signing: stipulated award with open medical, or full and final compromise.

☐ Price future medical — probability of surgery, injections, hardware, therapy, equipment — with someone who has seen it priced.

☐ Confirm every lien is quantified and resolved, not merely mentioned.

☐ Confirm the SSDI proration language is present.

☐ Confirm Medicare's interest is addressed.

☐ Read any resignation, release, or no-rehire term separately. It is an employment agreement hiding inside a compensation settlement, and it should be valued as one.

☐ Confirm the third-party claim is not being released by general language.

☐ Say out loud what closing medical means — that a future surgery for this injury is yours to pay for.

10B — The employer's checklist

☐ Report to the carrier within the statutory window — often days.

☐ Record the injury as required by 29 CFR Part 1904.

☐ Preserve the scene and the equipment if a third-party claim is possible.

☐ Issue a litigation hold if a claim is foreseeable.

☐ Make light-duty offers in writing and match them to the restrictions.

☐ Designate leave, and tell the employee the date it began.

☐ Engage the accommodation process at MMI, on the record. Note the limits: seniority systems, US Airways, Inc. v. Barnett, 535 U.S. 391 (2002); direct threat, Chevron U.S.A. Inc. v. Echazabal, 536 U.S. 73 (2002).

☐ Do not terminate a claimant without a documented, independent, pre-existing reason. Retaliation is outside exclusive remedy, and the general standard is broad — Burlington Northern & Santa Fe Railway Co. v. White, 548 U.S. 53 (2006).

☐ Collect certificates of insurance from every subcontractor, or become their statutory employer without knowing it.

☐ Investigate the pattern. Three similar injuries on the same task is a safety problem under 29 U.S.C. § 654 before it is a claims problem.

The deadline table

Deadline Typical window Runs from Consequence
Notice to employer Often 30 days; some far shorter The injury The claim, in strict states
Employer report to carrier Days Notice Employer penalties
Claim filing with agency 1–3 years State-specific trigger The claim
Appeal of a denial Days to weeks The denial The dispute
Utilization review appeal Short, expedited The denial The treatment
Change of physician State window First treatment The medical record
Third-party tort claim State statute, often shorter The injury The larger case
Safety-complaint retaliation 30 days — 29 U.S.C. § 660 The retaliation That claim
Discrimination charge 180 / 300 days — 42 U.S.C. § 2000e-5 The act That claim
Leave claim 2 years, 3 if willful — 29 U.S.C. § 2617 The violation That claim
Occupational disease Rule-supplied trigger Varies The claim

Who does what

The worker, in the first hour and the first week. Phases 1 through 3. None of it requires a lawyer, and all of it determines what a lawyer can do later.

The worker, ongoing. The treatment log, the mileage log, the symptom record, and consistency across every form signed anywhere.

Claimant's counsel. The AWW audit at intake, the treating-physician question, the causation letter, the third-party screen, the lien negotiation, and the settlement structure.

The treating physician. Causation, restrictions, MMI, and rating. The most useful thing counsel does is make sure the physician knows what sentences the record needs.

Employer and carrier. Prompt reporting, accurate wage statements, written light-duty offers, leave designation, and accommodation at MMI.

A benefits advisor, on SSDI offset and Medicare.

Failure modes, ranked

  1. Telling the first medical provider it was not a work injury, or guessing at a non-work cause.
  2. Oral notice only.
  3. Missing the third-party claim until the tort limitation has run.
  4. Accepting the carrier's average weekly wage.
  5. Missing the window to change treating physicians.
  6. Overstating limitations to the independent medical examiner.
  7. Refusing light duty without documenting the conflict with the restrictions.
  8. A gap in treatment, which reads as a gap in symptoms.
  9. Signing a full and final compromise without pricing future medical.
  10. Inconsistent statements across compensation, disability, and unemployment forms.
  11. Omitting a body part on day one.
  12. For employers: a light-duty offer that does not match the written restrictions.
  13. For employers: terminating a claimant without a documented, pre-existing reason.
  14. For employers: no certificates of insurance from subcontractors.

Items 1, 2, 3, and 11 all happen in the first week.

The authorities in one place

State compensation statutes are not reproduced here — there are more than fifty of them and they differ in detail. The federal provisions that sit alongside them, and that decide which system a worker is in, are these.

Provision Subject
5 U.S.C. § 8101 FECA definitions — federal civilian employees
5 U.S.C. § 8102 FECA entitlement
5 U.S.C. § 8106 Continuation of pay
5 U.S.C. § 8128 No judicial review of FECA merits
33 U.S.C. § 901 Longshore Act
33 U.S.C. § 904 Longshore employer liability
33 U.S.C. § 905 Longshore exclusivity; vessel-negligence action
33 U.S.C. § 908 Longshore compensation schedule
33 U.S.C. § 919 Longshore claim procedure
33 U.S.C. § 921 Longshore review
46 U.S.C. § 30104 Jones Act — seamen sue in negligence
45 U.S.C. § 51 FELA — railroad workers sue in negligence
45 U.S.C. § 56 FELA three-year limitation
30 U.S.C. § 901 Black Lung Benefits Act
29 U.S.C. § 654 OSHA general duty
29 U.S.C. § 660 Safety-complaint retaliation, 30 days
29 CFR Part 1904 Injury recordkeeping
29 U.S.C. § 2615 Leave interference and retaliation
42 U.S.C. § 12203 Disability retaliation
29 U.S.C. § 1132 Employee benefit plan claims

Leading cases on the federal side: Pacific Operators Offshore, LLP v. Valladolid, 565 U.S. 207 (2012) · Metropolitan Stevedore Co. v. Rambo, 521 U.S. 121 (1997) · Howlett v. Birkdale Shipping Co., 512 U.S. 92 (1994) · Cleveland v. Policy Management Systems Corp., 526 U.S. 795 (1999) on reconciling inconsistent disability statements · Raytheon Co. v. Hernandez, 540 U.S. 44 (2003) on neutral no-rehire policies.

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