What is workers compensation? It is a trade-off program, where employers and employee gets compensation for their injuries, during working hours. Employees surrender their right to litigate the employer for work-related injury or illness. On the other hand, the employer pays the injured employees medical bills, loss wages and temporary or permanent disability award.
Employers MUST carry coverage
An employer needs to hold workers’ comp coverage, all the time. If your coverage has lapsed and an injury occurs, then you will need to personally incur the employee’s medical treatment costs and pay penalties or undergo possible lawsuits.
Denials are challenges
Delays and denials are common and needs to be expected from claim adjusters and insurance carriers. Unfortunately, denial of your workers’ comp claim is disappointing and shocking. Claim adjuster’s always find some base to deny your injury to be work-related or you are really an employee.
Remember, a denial letter is not the last part of claiming process. You do not lose your right to chase the claim, but can challenge the insurance carrier’s decision by using the right procedure.
A confrontational case needs to be handled by professionals, who are trained to logically deal with facts.
Tips to locate a quality attorney
- Recommendations from trusted sources like colleagues, friends, and family
- Online is a great resource, especially local lawyers directory
- Treat initial consultation as lawyers job interview
- Look for an attorney, who encourages your confidence and treats you respectfully
Claim adjusters are suspicious people, who are always surrounded by claimants trying to dabble with the system or them. An attorney will assist you to organize the vital facts to strengthen your case and rise above the initial distrust of adjuster or employer.
Denial reasons
Many cases are denied because they are not legally correct. For example, you were away from the workplace, when you got injured. This is a valid denial, but it will depend on facts.
- Your injury related to travelling to and from work is not covered.
- If your employers need to have your own vehicle at work, so that you can visit different sites or run an errand, then travelling to work gets covered.
Thus there are many exceptions in commute to work rules.
Another example is re-injury to same part may result in delay or denial. However, law states that new injury to same body part is eligible to temporary/permanent disability and medical care benefits.
No significant medical evidence
Adjusters deny claim because the injured employee is not evaluated by Qualified Medical Examiner, but the fact is that all medical evidence state that injury is work-related. Actually, this is a trick to delay the claim conducted with a hope that you go away or give up.
In case your treating doctor fails to clearly state that the injury is industrial, then clarification is needed. You will be instructed to request panel QME. Panel of 3 QME doctors will be provided for you to select promptly or else the adjuster will do it. Take help from a popular attorney, because they likely know all or some of the doctors in the list.
Take attorneys help to challenge denial, because with their knowledge and experience, they can tilt the scale in your favor.
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