Tips for Making Sure Your Workers' Compensation Claim is Paid

Trouble with your insurance claim only adds insult to injury. Here are some tips to make sure your work injury claim goes smoothly.

Workers’ compensation insurance companies don’t like to pay on claims any more than they have to; they are always looking for a way to minimize the amount paid on claims. If you got injured at work, you are entitled to receive workers’ compensation benefits until you are ready to return to work. In order to reduce the chances of being wrongfully denied benefits or having your benefits prematurely terminated, here are some general rules to follow.

Report the Injury as Soon as Possible

Workers’ compensation laws require you to report work related injuries within a short time period, often 30 days or fewer. Although failure to immediately report the injury may not legally bar you from bringing a workers’ compensation claim, you should not wait. Workers’ compensation insurers will generally deny a workers’ compensation claim if the employee did not immediately report the injury. If you get hurt at work, and you think that your injury has the slightest chance of causing you to miss work, report it immediately to a supervisor. That will comply with state workers’ compensation laws and will help your chances of getting benefits as soon as you need them.

Get Names of Witnesses

If anyone witnessed your accident, make sure that you get their names. In a close case, you might need witnesses to prove that you were actually hurt at work, and not elsewhere.

Get Medical Treatment If You Need It

If you get hurt at work, make an appointment to go to the doctor. If it is an emergency, go or ask to be taken to a local emergency room or a walk-in clinic. Don’t wait. Insurance companies generally assume that, if you did not seek medical attention immediately, you weren’t that hurt.

Make Sure to Explain How You Got Hurt

Insurance companies will deny workers’ compensation claims if your initial medical records did not adequately describe the accident and the injury. This can be a problem as it was your health care providers, not you, who prepared the medical records. You should always do your best to clearly explain to your health care providers how you got hurt. You don’t need to elaborate; you just need to tell them the basics. But make sure that you say that it happened at work. The simpler you make your patient history, the better the chance that your health care providers will write it down correctly.

When you tell your employer how you got hurt, describe what happened accurately. Sometimes you can get hurt without any specific traumatic event that caused your symptoms. In such a case, it is possible that repetitive stress or overuse caused your symptoms. If you are injured, you work at a job that requires a lot of repetitive motions or long hours, and you think that your overwork caused your injury, you should report that. The insurer and the workers’ compensation system place great weight on the employee’s first report of injury. You should make sure that you describe what happened as accurately and as completely as possible.

Fill Out Accident Report Forms Accurately

Often employers require injured employees to fill out and sign accident reports. Once again, make sure that you fill out these reports accurately. If you feel too ill or medicated to fill out the report when the employer wants you to, then don’t fill it out at that time. Fill it out later, when you are feeling better and more able to concentrate.

Be Consistent in Your Statements

Insurers will often deny workers’ compensation claims if the employee’s statements about how the accident happened are inconsistent. If you tell your supervisor that the accident happened one way, but tell your doctor that the accident happened in a different way, that is going to hurt your case. Make sure that your statements are consistent.

Sign a Limited Medical Authorization to the Insurer

The insurer may ask you to sign an authorization allowing it to get copies of your medical records. This is a reasonable request, as long as the request is limited to the medical records and bills relating to your work injury. The insurer is entitled to see those records and bills. But you should not sign any authorizations allowing the insurer to get any other medical records or bills without discussing that authorization with a workers’ compensation lawyer.

Do Not Give a Tape Recorded Statement to the Insurer

The insurer will often ask that you give a tape recorded statement describing the accident and your injuries. As a general rule, giving such a statement will not help you if you do not have a lawyer. If you do not have a lawyer, you should not give a tape recorded statement to the insurer.

Attend Your Medical Treatment

Do not miss medical appointments. If you have a pattern of missing medical appointments, the insurer will assume that your injury is not severe or that you are healed, and will start looking for ways to terminate your benefits. If you are injured and unable to work, make sure that you get to all of your medical appointments.

Consider Talking to a Lawyer

If you're having trouble getting workers compensation benefits you know to be yours, consider talking to a workers' compensation attorney. A consultation with someone experienced in these cases may help you clear things up or determine if you would benefit from representation by a professional.

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