Tag Archives: Workers Compensation Claims

Workers Compensation Claim Denied

Workers Compensation Claim Denied

Workers Compensation Claim Denied

The last thing you expect after being injured on the job is to have your workers compensation claim denied. However, this happens all too often. You have the right to appeal a decision but if you try to appeal without legal help, you may find the outcome is less than satisfactory.

Employers are required by law to notify their workers compensation insurance company about any on-the-job accidents within 10 days of them being reported by the employee. Insurance companies may try a number of tactics to avoid paying the full amount of your claim including:

Workers Compensation Claim Denied

  • Injuries from other than job – one of the most popular tactics an insurer will use is arguing that your injuries were not a result of a workplace accident but occurred because of activities you participated in outside the job. To prove this claim, the insurer will often ask you to sign a medical release so they can access your medical records. It is never a good idea to give an insurer unfettered access to medical records that are not associated with your workplace injury. Speak to your worker’s compensation attorney immediately if they ask for this type of a broad release.
  • Make an offer you cannot refuse – sometimes insurance companies will make an almost immediate offer to settle your workers compensation claim. This is almost always a tactic that is used that allows them to settle a claim for less than it may cost them over time. For example, if your injury requires long-term medical care, you are entitled to receive not only the cost of medical care but transportation allowance to and from any medical appointments. For an insurer, offering a lump sum up front can be a far more cost-effective option.  If you do not already have worker’s compensation attorney, it is highly recommended you contact one before agreeing to any settlement offer.
  • Withhold benefits until you settle – another common tactic insurers may use is to stall payment of benefits until you are facing crippling financial problems and then offer you a settlement. This is because most insurers know that workers can only hold out so long without the income from their worker’s compensation claim. This method often works because employees who are out of work need the money sooner rather than later. Unfortunately, this also means you are likely to waive compensation for future medical care.

After your workers compensation claim has been denied, you are entitled to appeal that claim.  If your workers compensation claim is denied or insurance companies are using unusual tactics to avoid paying your claim you need to contact an attorney immediately to help protect your rights under Georgia’s workers compensation laws.

Top Mistakes That Delay Workers Compensation Claims

workers compensation claims

Top Mistakes That Delay Workers Compensation Claims

When filing a workers compensation claim, attorneys and clients must be aware of companies and the mistakes that can hold up the progression of claims. Here are the most common mistakes that occur within the workplace;

  • Time Lapses

When an accident occurs, a workers compensation claim should be filed as soon as possible. Many times, employers do not stress the importance of claimants reporting the accident or filing their claim in a timely manner which can then hinder the investigation.

Workers Compensations Claims

  • Lack of Proper Investigation

When a worker has an injury, the immediate supervisor is responsible for investigating the occurrence, but does not always do so. This impacts the claim, because the information is not fresh.

  • Inadequate Documentation

Having thorough and complete notes during the entire investigation is key. Every witness should have a signed affidavit, and the accident should be secured immediately. It is imperative that pictures, diagrams and any medical reports are accurate, but this is not always the case.

  • Communication

The employer often loses touch with the claimant once they are out on an injury, failing to keep them in the loop on the progress of their claim.

  • Lack of Medical Release

The claimant should sign a medical release at the time of the injury. This is a requirement to obtain the medical records needed to move forward with the claim. Employers often wait to get this information, which delays the claim.

  • No Transitional Programs

Quite a few employers do not have a light-duty or transitional program to allow the injured worker to come back to work, which can eliminate large claims or minimize the expenses.

  • Being Passive

When an employee is hurt on the job, the employer’s responsibility is making sure the injured worker gets the medical attention they need.  Many employers are not timely in their coordination of care and are passive about the employee’s well-being and their return to work.

  • Lack of Job Safety

Hiring people who have not been properly trained; not posting safety rules, and neglecting to keep adequate records can hurt the employer’s defense and delay the claim.

  • Lack of Understanding

In most cases, the employer is the first person contacted after an injury. Knowing the rules and regulations associated with workers compensation is important. Many employers do not understand what their role is, which delays claims and medical attention. They should have a working relationship with the claims specialist to understand the process from start to finish.

An attorney will work with you to pinpoint these deficiencies and assist in getting your claim approved, paid and if possible, get you working once again. A workers compensation attorney specializes in getting your case heard and addressed to achieve favorable results.

Call Skip at McManes Law a Workers Compensation attorney working for you