Workers Compensation Claim Letter of Notification…

A workers compensation claim is handled differently than other types of personal injury claims. You must write a letter of notification to your employer and their insurance company, and file a govermental claim form with your state’s workers compensation board.

These types of personal injury cases are referred to as either Workman’s Compensation Claims or Workers Compensation Claims. They both mean the same thing and the terms are often used interchangeably.

Let’s explain the workers comp process using an example…

You’ve worked for a tire company for about nine (9) years. Your primary responsibilities are to deliver tires to suppliers.

You are about to finish your last delivery for the day. At the supplier’s warehouse you are pulling tires. A couple of large ones had become caught up during the ride. As you pulled them apart you suddenly felt a severe and shooting pain through your entire back.

While at the hospital you learn that you have two (2) herniated disks in your lower back. You won’t be able to work for a while and the costs of recovery will be substantial.

In almost all cases, if you are injured on the job while engaging in legal work related activities you are entitled to workers compensation benefits. If though, while on the job you are engaging in illegal activities at, or close to the time of the injury you will not be entitled to benefits.

Each state has it’s own time period for filing a workers comp claim. Contact your State Worker’s Compensation Board to confirm the time period for filing a claim in your state and to obtain the necessary forms. Although each State is different, the following benefits are usually attached to workers compensation claims:

  • Medical care to treat the injury
  • Temporary payment for lost wages
  • Prescriptions
  • Mileage reimbursement for trips to the doctor
  • Physical therapy benefits
  • Nursing or Attendant care
  • Prosthetics
  • Health Aides
  • Vocational Rehabilitation

If you are injured on the job and wish to file a workers comp claim you must notify your employer as soon as possible. This will set in motion the process of obtaining compensation for your injuries. Some states require notification within twenty one (21) days and some allow up to thirty (30) days. Again, be sure to check with the Workmans Comp Board in your state.

At or about the time you notify your employer you must ask which Doctors are on his approved list (it’s a little like an HMO where you have to see the Doctors on the list first).

If you are unable to ask because of the seriousness of your injuries, anyone over 21 can ask for you. In most states your emergency room bills will be reimbursable. Once stabilized though, you must see the doctors on your employer’s Workers Compensation Insurance Plan.

It is important to be efficient with your Notification Letter. The letter should not be accusatory or threatening, and no whining. Just follow the steps outlined in the below sample Notification Letter for workers compensation claims and you will be ahead of the game.

Tips and guidelines to follow when writing your letter…

(Each alphabetical letter has a corresponding letter in the sample notification letter which follows.)

  1. Clearly state your name, date of birth, social security number, and date of injury. This can be accomplished at the very beginning of the letter in the “Re:” section.
  2. State that you were working for your Employer the day of the injury and that you were injured while performing your duties.
  3. So there is no question about whether you were injured while performing your duties, explain exactly what you were doing at the time of the injury.
  4. It is crucial that you state you had no previous injury to your back (or whatever part of your body was injured). If there is any question whether you had a previous injury your claim will either be denied or, if approved, the amount will be a lot less. That is because the Workers Compensation Board may consider your injury an exacerbation of a previous injury, not a separate and new injury.
  5. Relate any information from the Doctors such as treatments, tests and diagnoses. Don’t say what injuries you think you’ve suffered. (Although you may not know the full extent of your injuries at the time of the Notification Letter, do your best to communicate to your Employer the type of injury you are being treated for.)
  6. Be sure to request a list of Doctors who are members of your Employer’s Worker’s Compensation Insurance Plan.
  7. Because you will have some time before sending your Notification Letter you should be able to state the approximate length of your recovery and any damages you will incur. Don’t worry if you forget to mention an additional test or treatment. Most State’s laws require that you only make a “good faith” effort to notify your Employer of such items.
  8. H. Confirm with your Employer that he has taken the proper steps related to your claim, including his timely notification of your injuries to the State Worker’s Compensation Board.
  9. I. Although not legally required it’s always a good idea to end your Notification Letter by telling your Employer you will be fully cooperative. This will help to preclude any future rumblings about alleged non-cooperation.


In addition to notifying your employer you must also notify your State Worker’s Compensation Board. Each State’s forms are different so don’t forget to go online and download the one for your State. There are also time limitations which vary from State to State.

Once receiving your Notification Letter your employer also must notify the Workmans Compensation Board. Depending on the State, he must do so within the prescribed period set out by the Board.

Keep in mind that the mere filing of a workers comp claim does not guarantee approval. Your Employer has the right to contest your claim if he believes…

  • you were not as severely injured as you say; or
  • your injuries did not occur while on the job; or
  • you had previously been injured and this occurrence was only an exacerbation of the original injury (if so, that would make the benefits much less); or
  • that you may have been involved in illegal activity at the time of your injury (e.g. drinking and driving).

There are more reasons a workers compensation claim could be contested, but the examples above are the most frequent.

In other personal injury claims, at the end of your recovery you would send a Demand Letter to the culpable party. In it you’d seek reimbursement for actual damages (“hard costs”) and an amount for pain and suffering.

In workmans comp cases there is no Demand to the employer. At the time of your injury your workers compensation claim was either approved or denied by the State Board. If denied you would already have access to an appeals process.

You can’t just leave the Notification Letter with anybody at the job. Delivering it to someone in management will be considered effective notification.

With workers compensation claims there are no provisions for Pain and Suffering. If your claim is approved, your medical and other injury-related bills (including lost wages) will be reimbursed so at the end of your recovery you are back at the place you were before the injury… but that’s about it.

Below is a SAMPLE letter notifying an employer of a workers compensation claim. For your claim, try and match the substance of the following letter as best you can, substituting the specifics of your case.
—– START Workers Compensation Claim Notification Letter —–

(Your Name and Address) MR. JONATHAN L. PIERCE
15562 Ellington Avenue
Dallas, TX 75247

Telephone: (214) 689-XXX9

January 14th, 2011 (Date of Letter)

Mr. Justin Marotta (Your Employer)
Certilman Motors
1243 Ventura Highway
Blue Point, NY 11772

DATE OF BIRTH: 2/25/1967
DATE OF INJURY: 1/05/2011

Dear Mr. Marotta:

I have been employed at Certilman Motors since February 14th, 2002. On January 5th, 2011 I was delivering One Hundred Seventy Five (175) tires to one of our regular customers.

(B) I had just about unloaded all of the tires when I saw two (2) of the remaining tires were caught up with each other. I knew I would have to pull them apart. I had done this many other times on different deliveries. Sometimes the larger tires would get hung up with other tires and the only way to separate them was by puling them apart.

(C) As I began to pull the tires apart I felt a sudden jabbing pain in my lower back. I knew right away I was in trouble. I was unable to straighten up and I began to writhe in pain.

(D) Prior to this injury I had never had any problems with my back. I considered myself to be in all around excellent health, having missed very few days of work in the past nine (9) years in your employ.

(E) While at the hospital, and after having an MRI (Magnetic Resonance Image) I was told I had herniated two (2) disks. My recovery is going to be difficult and as a result I will incur Medical and other bills. In addition, during my recovery I will be unable to work.

(F) I am told I’m supposed to ask you which Doctors I am to see from now on. I understand that is part of the way Workers Compensation works. In that regard, would you be kind enough to provide a list of approved Doctors and Chiropractors so I can be sure to seek treatment from them.

(G) I am told my recovery will take approximately three (3) months.

During that time I will be unable to work. I have also been told surgery may be an option, although there are no guarantees of success. During my recovery period I will be dealing with the following:

  • Medical care to treat my injury
  • Chiropractic treatment
  • Temporary payment for lost wages
  • Prescriptions
  • Mileage costs when my wife drives me to the doctor
  • Rehabilitation benefits
  • Nursing or Attendant care for those times I am confined to bed and my wife has to work
  • Prosthetics
  • Vocational rehabilitation

(H) I am confident you have taken appropriate steps to notify the State Worker’s Compensation Board. I have already filed my Workers Compensation Claim form with them.

(I) If you require any other information from me regarding my injury and recovery please do not hesitate to contact me. Yours truly,

Jonathan L. Pierce

—– END Workers Compensation Claim Notification Letter —–

Being injured on the job is something we all dread. And if being injured wasn’t bad enough you have to go through all the red tape, which is unfortunately part of our national workman’s compensation system. Yet you must take action to protect yourself and your family. Your monthly bills will continue to come at the same rate they did before your injury.

You should know how to file a Workers Compensation Claim to get financial help while you are recovering and unable to work. Don’t be afraid to come back to this site during the claim process and ask a workers comp question. We have attempted to guide you through the process of filing your own Workers Compensation Claim. If you follow the guidelines and tips above you should be able to get through the process successfully.

Remember, each State’s Workers Compensation Board has its own unique rules and regulations. You should be able to find all the relevant info and downloadable government forms at your State Board’s website.

Taking what you have learned from this website and applying it to the Workers Compensation Claims process should afford you the confidence and peace of mind necessary to pursue a successful claim.

From this point on continue your recovery and make sure you hold on to every single receipt related to your treatment, from the ambulance ride, to the receipts for parking at the doctors office, to the days you missed work, etc. Keeping organized records is extremely important.


It’s also important to note that if you were injured by the negligence of another party while at work, you may be able to file a separate personal injury claim against the negligent party in addition to your workers comp claim. It’s always a smart idea to speak with a licensed attorney in your area to discuss the specifics of your case.

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