Many workers’ compensation claims are approved in a relatively timely and orderly way. After a period of review, the insurance company approves the claim and issues its General Admission of Liability, and the injured worker gets medical and wage replacement benefits.
But workers’ compensation cases can be disputed for a variety of reasons. In these situations, the insurance company will send the injured worker a Notice of Contest form stating the reason for the denial of the claim. The injured worker has the right to appeal the denial, but such an appeal can go on for months. Eventually, an administrative law judge will hear the case and issue a ruling, but even then that decision can be appealed.
Six ways an injured worker can lose
Between the time a worker is injured and the case is finally resolved, a lot can happen. During that time, here are six ways by which an injured worker can lose his or her case:
1. Failing to meet required deadlines
There are some important deadlines that must be met:
An injured worker must report the injury to his or her employer in writing within four days.
If the worker wants to appeal a Notice of Contest (denial), he or she must file an Application for Expedited Hearing within 45 days of the mailing of the notice.
If the worker objects to the Final Admission of Liability, he or she must file an objection within 30 days.
Failure to meet any of these deadlines can provide the insurance company with a good faith reason to deny the claim.
2. Failing to be proactive in obtaining the medical care you need
Your employer may direct you to one of its preferred doctors for a medical examination. Some of these medical professionals tend to minimize the extent of workers’ injuries. As a result, you may not get all of the medical care you need to reach the point of maximum medical improvement. Or the doctor may insist that you can go back to work before you are really ready to work.
You have the right to obtain an independent medical review. This doctor can provide an objective diagnosis, increasing your chances of getting the medical care you need.
3. Trusting your employer or the insurance adjuster
After your accident, your supervisor, senior management, and others at your employer may express genuine concern about your health. Behind the employer though, looms the insurance company and it has one over-riding objective: to minimize its claim costs.
Do all of the paperwork, double-check it, and get advice from an experienced workers’ compensation lawyer.
4. Lying or exaggerating about the accident and your injuries
When informing your employer about the accident, be honest when describing what happened. When talking to doctors or other medical professionals, don’t exaggerate when describing your symptoms or the intensity of your pain. When testifying in a hearing, you will be under oath, so tell the truth. And don’t hide anything from your lawyer.
5. Being careless on social media
These days, insurance companies often employ investigators who comb through Facebook, Twitter and other social media platforms. They are looking for information they can use to defeat claimants’ cases. That picture of you on skis or playing softball while you are seeking benefits may be the smoking gun that causes you to lose your case.
6. Not getting a lawyer
You may be tempted to go it alone. But know that attorney fees in workers’ compensation cases are set by law, and in most cases, you will not owe a fee unless and until you receive benefits. An experienced workers’ compensation lawyer has seen just about everything, knows the stratagems and tricks used by insurance companies, and can respond appropriately.