Sometimes, a workers’ compensation claim is simple. A person is hurt at work, reports it to the company, the company’s insurer pays the employee’s medical treatment and weekly benefits.
But insurance companies don’t pay every claim. That means some claims are denied. Sometimes there is a good reason, but sometimes the insurance company is wrong to deny a claim. There are a lot of reasons this can happen, from lack of communication, to missing information, or even just a mistake.
If your benefits have been denied, here are 5 steps is to make sure the insurance company has all the information it needs.
1. Have you notified your company that you were hurt at work? Make sure your HR department, supervisor, or manager have all the information about when and how you were hurt, anyone else who saw it, and that you are out of work because of your injury.
2. Has the insurance company been notified of the claim? HR or your manager should know how to contact the insurance company and tell them about the claim. There should be a poster at your workplace with the insurance information.
3. Has a claims adjuster been assigned to your file? Be sure that you have the person’s name and contact information correct. Ask them what they need to approve your claim.
4. Have you provided your medical records to show what your injury is and that you are unable to work? Get a copy of your medical records from your medical provider and give a copy to the insurance company. They don’t need to see all of your medical records, but they do need to see records relating to your work injury, treatment, and any restrictions from work.
5. Have you told your providers that your injury is work related? Your doctor will need to send bills to the insurance company and get approval for your treatment from them. They can’t do this if they don’t know it’s a workers’ compensation case.
If you have done all of this, and your claim is still denied, or if you are having trouble with any of these steps, you should talk to an experienced workers’ compensation attorney. It is a special area of the law, with it's own laws and procedures, so ask friends or family for the name of someone they have used. You should be able to find someone in your area. It shouldn't cost you anything, because in workers’ compensation cases, the insurance company pays the attorney fees.
Some workers' compensation cases are simple, but many are not. Everything can seem confusing and like it takes a long time. Having someone who knows the procedures can make the whole process much easier and less stressful.