Workers’ compensation claim denials are hardly uncommon. Insurance companies are very good at attention to detail and will look for even the slightest reason to deny your claim. However, being prepared and knowledgeable about how workers’ compensation claims work can be invaluable. If you’ve been injured at work and have or will file a workers’ compensation claim, arm yourself with these facts:

The Importance of Reporting

The first and the most critical step after being injured at work is to file an accident report with your employer. Whether the injury is severe or minor, it’s important to properly document the incident should your injury turn into a bigger problem in the future. While preparing your accident report, you should include the following:

  • Explanation of how the accident happened
  • What parts of the body were injured
  • Who the accident was reported to
  • List any witnesses that were present when the accident happened

Work injury reports can also be very helpful should an interview be necessary. It can assist in jogging your memory of the events leading up to your injury.

Common Causes of Claim Denial

There’s a host of reasons why workers’ compensation claims get denied. Fortunately, you do have the right to appeal. The appeals process can be taxing, but the first step to getting a favorable outcome on your appeal is to understand why your claim was denied. Here are some common reasons:

  • The injury was not reported in time
  • Missed deadlines
  • The claim was disputed by the employer
  • Claimant failed to obtain medical treatment
  • Insufficient evidence to support the injury happened at work

Workers’ Compensation Appeals

Once you know the reason why your workers’ compensation claim was denied, you can work on getting the decision appealed, but be aware it can be a complicated process. Here are some things that need to be considered:

  • Did the Denial Occur Due to an Error?
    If you suspect that there was an error in processing paperwork, you may be able to forgo an appeal by contacting the claims adjuster so they can correct the error. Just know that claims adjusters aren’t known for being very cooperative so you may hang up the call without a successful outcome. If you cannot get a resolution on the spot, you ‘ll need to appeal your claim.
  • Appeal Instructions
    It’s important to read the denial letter carefully and follow the instructions on how to start the appeals process. During the appeals process, you may be required to appear before an administrative law judge and present medical and other evidence to support your work injury claim.
  • The Importance of Having a Workers’ Compensation Lawyer on Your Side
    Appealing a workers’ compensation claim on your own will not be easy. Without knowing the laws or fully understanding the appeals process, you can jeopardize your case. Claimants who are representing themselves in a workers’ compensation appeal are expected to know all the laws, rules, and procedures. You have your injury to worry about and having legal representation can ease your burdens and help you present a strong case.

Choosing The Right Doctor

Having a doctor that is supportive and qualified to treat your work-related injury is a vital component to the success of your claim. While your family doctor may have been treating you for decades, they may not be the right choice. Your doctor’s experience with workers’ compensation claims could make or break your case.

How Much Experience Does Your Doctor Have With Work Comp Claims?

While your doctor is responsible for the treatment and care of your work injury, he is also responsible for reporting, filling out proper forms and meeting deadlines. Any missed deadlines or improper information could delay your benefits payments — or could result in a claim denial. Your doctor should also be aware that a “request for authorization form” must be submitted before any treatment can begin. Any treatments performed without prior authorization may not be covered under workers’ comp.

Insurance Company Communication Do’s and Don’ts

What you tell your insurance claims adjuster could affect your case in a negative way. Here are some do’s and don’ts to know so you can avoid a workers’ compensation claim denial:

The Do’s:

  • Do take the adjusters information – Note their name, address, telephone number, and any other pertinent information.
  • Do take notes during your call – Your notes can help you better communicate with your attorney, and can also act as a reference tool should a problem or discrepancy arise in the future.
  • Do contact a workers’ compensation attorney – Let an experienced workers’ compensation lawyer cut through the “red tape” and handle the often complicated logistics of a worker’s comp claim so you can focus on healing.

The Don’ts:

  • Don’t let the adjuster record your conversation – If they ask you to agree to a recorded conversation, simply decline. By law, they are not permitted to proceed with recording. Giving them permission opens doors for them to use something you say against you in your case.
  • Don’t allow small talk to get in the way – A claims adjuster will attempt to get you as comfortable as possible for you to spill more detail and facts that you need to. Just stick to the basic facts of your accident and injury.
  • Don’t sign ANYTHING: Do not sign any documents or medical release forms without the review of an attorney.

If you have been injured at work and need assistance with filing a workers’ compensation claim or appeal, Law Offices of Bo Katzakian can help! Contact us at (844) 311-7793 to set up a free case evaluation today!