Mistakes to Avoid When Applying for Workers’ Compensation

Mistakes to Avoid When Applying for Workers’ Compensation Workers’ compensation is granted on the basis of a medical chart review.

Read about the mistakes to avoid when claiming these benefits.

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Workers’ compensation insurance for employees injured on the job is required by law in the United States for businesses with three or more employees. The benefits are granted only on the basis of a detailed medical chart review to determine the nature of the injury and the extent to which it has disabled the worker. The insurer may not always grant the insurance benefits and even if they are granted, workers may not get the expected amount. Sometimes, the benefits may be denied altogether. There are many reasons for this denial.

What are the mistakes an employee can make that could lead to a denial? 

The employee does not get immediate treatment for the injury: Sometimes, after an accident, a worker may choose to wait and see if the condition improves before visiting a doctor. This could lead to additional physical harm and also claim denial on the part of the insurer. To file your workers’ compensation claim, you need a report from your doctor and therefore obtaining medical treatment early and receiving a diagnosis is necessary to obtain the coverage due. When visiting a doctor, inform her that your injury happened while working and confirm your employer for billing purposes under a workers’ compensation claim.

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The employee doesn’t report the injury to the employer: Employees must report their injury within the specific number of days via a written notice to their employer. The number of days may vary with individual states. It is essential to do this so that any dispute regarding proper notice is avoided. The statement should clearly describe the nature of the injury and the date of the accident.

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The employee fails to follow the doctor’s orders: Medical evidence is vital in any workers’ compensation claim. Injured workers must follow doctors’ orders for treatment, medication, rehabilitation, and also keep all appointments. If the employer or insurer believes that the employee is not making an effort to recover, the benefits could be suspended or even terminated. If the employee disagrees with his/her doctor’s orders, they should go for a second opinion from another doctor belonging to the same specialty.

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No “increased risk” is associated with the worker’s injury: Just because an injury occurred at the workplace, it doesn’t qualify for workers’ compensation. If the injury is one that could have happened just as easily to anyone in the general public, it may not be

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considered as a work injury that could be considered for workers’ compensation benefits.

The worker will have to prove that the job created an “increased risk” of his/her injury. 

The injury didn’t happen in the course of the worker’s job: Though the worker may believe the injury is work-related, the law may not agree (as for example if the injury occurred when driving to work in the morning). If the circumstances of the injury are vague, the insurance company could argue that it is not a job-related injury.

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The employee believes she doesn’t have a claim because of a pre-existing condition: An employee hurt while on the job and is currently unable to work because the injury aggravated a pre-existing condition, may have a valid workers’ compensation case. To prove this, the employee must produce evidence that the pre-existing condition was aggravated by the accident.

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The employee returns to work too soon: Typically, the employer’s insurer may ask the employer to find some work the injured employee can do as he/she recovers, or claim that the employee is fine to return to his/her pre-injury position. The job offered must pass medical and legal scrutiny. In other words, the job offer must clearly specify what the job is, what duties the employee will be asked to perform, the pay and other details. It is important that employees request a description of proposed job duties and have their doctors review it to ensure they can do the work. No work should be done without the doctor’s approval because this is important for the sake of the employee’s health and the receipt of full benefits.

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The employee lacks credibility or doesn’t have a good work record: If the employee doesn’t have a good record for honesty, or a good work record, it could be quite damaging. The circumstances surrounding the accident and injury, the worker’s level of pain, his/her ability to work – all these should be credible if he or she is to receive workers’ compensation benefits. An employee who has filed many claims in the past is not likely to get the claim accepted easily.

A number of honest workers are injured at work and apply for workers’ compensation benefits.

There are also employees trying to cheat the system and get paid for an injury that did not occur at work, or one they present to be far more serious than it actually is. Insurance companies, whose duty it is to separate false claims from honest ones, use many methods including medical

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peer review provided by a company offering medical review solutions to exclude those lying about their condition. For the applicants, hiring a workers’ compensation or insurance attorney is the best option. An experienced attorney will keep the employee informed when making decisions about the case.

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