Is an Insurance Company Refusing to Pay for Serious Work-Related Injuries?

Is an Insurance Company Refusing to Pay for Serious Work-Related Injuries?

Work-related injuries and illnesses affected the lives of 2.9 million workers in 2016. Those numbers have risen 48,500 since 2016.

When someone has an accident at work and it’s serious enough where work is missed and medical bills begin to pile up, it’s time to make a claim with the insurance company.

Unfortunately, sometimes an insurance company decides to reject the claim. When that happens, here’s what you need to do.

Report the Injury

In a perfect world, as soon as the accident at work happens, it should be reported. That doesn’t always happen and it can create problems when you try to file a claim.

Workers compensation laws require the injured party to report the accident within 30 days or fewer of it happening.

To protect yourself, as soon as you realize you’re going to miss work because of your injuries or illness, report it immediately to your supervisor.

Get the Names of Witnesses

If anyone witnessed your accident at work, get their names.

If anyone tries to claim your accident happened elsewhere, you have proof to back up your claim.

Finish Your Medical Treatment

Do not skip any doctor’s visits. First, it’s important for your own health and well being to make sure you get the proper care you need.

But if you skip visits, the insurance company can also claim that your injuries are not as serious as you’re claiming. They can refuse to compensate you or even terminate your benefits.

If your employer asks you to visit a specific hospital, clinic, or doctor go wherever they ask you to go. Obviously, that’s out of your control if you’re taken away from work in an ambulance.

Accurately Explain How You Were Hurt

Take the time to accurately describe the accident at work. The insurance company can deny your claim if the accident and injury are not described adequately.

This is a big deal because it’s the health care providers who prepare the medical records, not you.

Do not forget to mention that your injury happened while at work. There’s no need to go into great detail. In fact, stick to the basics since it lessens the chance of inaccuracies being added to your medical history.

There are cases where no specific traumatic event happened that caused your injury. It could be repetitive stress or overuse that caused your symptoms.

Injuries can also result from long hours and repetitive motions. It’s important to make a report each time an illness or injury happens as a result of work so it’s properly documented should something worse happen where you need to seek medical attention.

Make sure you also tell your employer exactly what happened to cause your injury. The insurance company will place a lot of weight on how and when you reported your injuries.

File All Forms Properly          

If your place of employment requires you to fill out and sign an accident report, make sure you do so accurately.

If you’re not feeling well at the moment, wait until you can properly focus so you can describe the accident at work.

Fill out your worker’s comp form as accurately as you can as well. All too often, a slight mistake can make the difference between an approval and a denial.

Be Consistent

Every time you share the story about your accident at work, be sure to state it the same way every time. Consistently is extremely important to insurance companies.

If an insurance company reads all the reports and finds that you described the incident one way to your employer and another way to your doctor, they have reason to deny your claim.

There’s also a lot of insurance fraud being committed. So much so that it’s costing us $40 billion per year. That causes all of our premiums to be raised.

If you provide inconsistent stories, your employee and/or insurance company may suspect you of fraud. To ensure you stay healthy and out of jail, make sure you tell the same story every time.

Sign a Limited Medical Authorization to the Insurance Company

You may need to sign an authorization form from the insurer in order for them to obtain copies of your medical records. This is a reasonable request for them to make.

However, it’s only reasonable if the request is limited to the medical records and bills that relate only to your work injury. The insurance company is entitled to see those records and bills.

If they ask you to sign any other authorizations to take a look at other medical records or bills without discussing why they need it or they fail to provide a reasonable excuse for why they need those additional records, contact an attorney.

Refuse to Provide a Recorded Statement Describing Your Accident at Work

It’s not uncommon for the insurance company to ask you to give a tape-recorded statement that describes the accident at work and your injuries.

Do not agree to provide one unless you are already working with a lawyer who gave you the go-ahead.

Providing such a statement without a lawyer usually will not benefit you in any way.

Find Out Why You Were Denied

If you are denied, contact the worker’s compensation insurance company. Ask to know why you were denied.

Sometimes, it’s because of information being lost or employee error. Other times it’s because the insurance company doesn’t want to pay.

They know that many times, people won’t follow up on a denial. Don’t allow them to get away with it. Follow up and hire an attorney if you need help.

Send the Bills to Your Health Insurance Company

If you have health insurance, give your health insurance information to the medical provider. Have them bill your health insurance in case worker’s compensation refuses to authorize necessary treatments.

While health insurance companies are not required to make payments for work-related injuries, they are required to pay them when worker’s compensation denies it.

This ensures you’ll be able to receive all necessary treatment as soon as possible.

Make an Appeal

If you are denied, appeal. In many cases, it’s easier for you and your family to hire an attorney who is familiar with worker’s compensation.

Worker’s compensation is extremely complex and new changes have been made. If you’re already suffering, it’s easier to work with someone who is knowledgeable about the rules and regulations.

Our law firm works exclusively with injured workers. We want to help you get the help you deserve. Contact us today for a free consultation.

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