The Secret of Successful Workers’ Compensation Claims

Tuesday, June 27, 2017

The Secret of Successful Workers’ Compensation Claims

Written by Malman Law, reviewed by Steve J. Malman.

Worker’s Compensation Attorney Helping Chicago’s Injured Successfully File Claims

Employers rely on their insurance carrier to guide them through the workers’ compensation claim process, but what do you have?

A claims representative is there for the employer. They guide them through the filing process, and they help find the proper care providers for your request. However, you are left without any guidance and often find yourself amidst various rules and guidelines that do not make sense or help you recover from your injuries.

To increase the likelihood your case will succeed, there are a few insider tips that you must use. Also, it is in your best interest to work with a workers’ compensation attorney. An attorney can help you file your workers’ compensation claim and receive the compensation you need for your work-related injury or illness.

Always Report the Injury to a Supervisor Immediately

If you are injured on the job, you might feel uncomfortable reporting an injury or illness to your supervisor. However, you are required by law to report your injury as quickly as possible.

It is the first thing you should do and presuming you have not sought emergency medical attention; you should do so before leaving to the doctor. If you discover a work-related illness, you can notify your supervisor the moment you hear the diagnosis.

If you do not report the work-related injury or illness, the carrier can deny your work-related injury claim. The sooner you report it; the less likely you are to deal with this.

Also, when you report your injury to your employer, make sure you inform them about all areas of the body affected. Do not leave out symptoms or details. Then, request a written incident report for your files.

Report Your Injury as Work-Related to All Providers

Anytime you are dealing with a work-related injury or illness, it is imperative that you keep proper documentation and ensure all parties are aware that you have a work-related injury. Therefore, every health care provider you see should be mindful of the fact that you are seeking treatment for a work injury or illness.

One of the first things the insurance company will do is review your medical records and see if you told them about the work injury. Therefore, you want proper documentation throughout to ensure that each treatment, diagnosis, and prescription written ties into the injury.

Follow the Instructions of the Medical Provider

Your physician will have diagnostic studies, and then they will come to a treatment plan.

You must follow that treatment plan in its entirety. For example, your doctor might order physical therapy. While you might assume that you do not need the treatment, never miss the appointment. Instead, you can discuss it with your physician or seek a second opinion. Failing to show for medical treatments, however, only gives the insurance company grounds to deny your claim or stop paying on claims.

Your Obligations as an Injured Worker

As an injured worker, you are obligated to attend all medical appointments. You must attend the scheduled appointment to ensure you recover, but also comply with the benefits and policies of the workers’ compensation insurance coverage.

Insurance companies assume that if you miss an appointment, you are not injured like you claim or you have healed; therefore, they have grounds to terminate your coverage.

Hire Your Advocate – Do Not Rely on Your Employer or the Insurance Company

The employer has the insurance company for advice, but they also pay that insurer for their advice. You cannot solely rely on your employer or the insurance company to guide you through the process. If you do, you could be setting yourself up for a limited amount of compensation.

Instead, you must find your advocate who will guide you. After all, the insurance company is a private business seeking profits. They are there to make money and reduce how much they spend on claims. They might advise you against certain treatments, even if you need them, to lower their costs and overall burden.

Communicate with Employers Constantly

You must remain in constant communication with your company and keep the line of communication open. Even if you are away from work for several months, you must update them on your progress. Any employment-related matters must also be addressed.

If you need to arrange light duty work when you start to return, you must discuss your options with your employer and see what employment options they have to accommodate your injury. This not only reduces tension between you and your employer but ensures that everyone is on the same page regarding your prognosis and the expected outcome.

Stay in Contact with Your Representative

You will have a workers’ compensation insurance representative assigned to your case. They will be your point of contact when you submit medical bills or call to receive payments. Therefore, you must remain in contact with them. If they request documentation from you, send it to them promptly. The longer you take to provide them with documentation, the harder it is to seek compensation or receive cooperation from the insurer.

Know the Reasons Why Claims are Denied

Often workers compensation claims are dismissed based on a technicality and nothing more. If you want to have a successful workers’ compensation claim, there are certain items that you must pay attention to, including:

An Injury that Has Not Witnesses

Workers’ compensation will scrutinize any injury that occurs without a witness. Therefore, look for witnesses that are nearby at the time and see if they saw the accident. If there are no witnesses, do not assume you cannot seek compensation. Instead, report the injury to your supervisor immediately.

Failure to Report an Injury Promptly

A common reason for a denial is that the injury was not reported immediately after. If you do not report your injury or illness immediately, the insurance company will assume that you were not hurt. Also, you are required to report in a short timeframe. So, immediately complete the accident report.

Your Accident Report and Medical Records Do Not Correlate

Your records should all tell the same story. If your medical files and the accident report do not have the same information about the injuries or how the accident occurred, you are going to face issues with the insurer. Make sure that when you tell anyone about your accident, you tell the same story. Do not embellish or leave out details that can create confusion. Also, be sure you tell your doctor the same story that you told the supervisor to keep records consistent.

Medical Records Indicate Drugs or Alcohol

While you can receive compensation for a work-related injury, even if you were at-fault, you cannot if you were under the influence of drugs or alcohol.

After a work-related accident, the physician or emergency room doctor will do a drug and alcohol screening as part of their protocol. Therefore, if any trace amounts are present in your blood or urine, the insurance company will deny your claim.

You Were Injured Outside of Work

While you can receive compensation for work-related injuries, you can only do so if you were performing your regular employment-related tasks. If you were on a lunch break or not on duty, and you were injured, the insurance company might deny the claim.

To qualify for workers’ compensation insurance coverage, you must be injured while performing your job duties or while on your employer’s time. Injuries that happen outside of regular employment duties will not qualify for compensation.

You Refuse to Cooperate with the Insurance Company

While you are not required to give them a recorded statement without an attorney present, you must give an official statement and sign your medical release forms so that the insurance company can accurately assess your injuries and claim. If you do not, they have the right not only to deny your claim, but you may be unable to file a claim again in the future.

The employee is not required to provide a statement, but if they ask for one, they are telling you that they have a problem with your case. You can, however, request that your attorney is present for the statement so that your rights are protected.

Want a Successful Workers’ Compensation Claim? Speak with an Attorney

To have a successful outcome to your workers’ compensation claim, it is best that you speak with a lawyer. An attorney with experience in workers’ compensation claims can help you not only file your claim but ensure that small missteps do not bar you from receiving the benefits you deserve.

If you have suffered a work injury or illness, report the injury to your employer. Then speak with an advocate from Malman Law to explore your options. Our attorneys are here to help you through this difficult time. We understand that you have questions and concerns, and we can assist you with your claim, but also answer those questions so that you are prepared for the process.

Schedule a workers’ compensation consultation today at (888) 625-6265 or request more information online.