If you’re an employee, chances are you’re covered by insurance thanks to workers compensation law in Ohio. Workmen’s comp helps reimburse employees medical expenses incurred because of a workplace injury. But unfortunately, it’s not always as simple as submitting some paperwork and receiving a payment.
Insurance companies do have a bottom line and they will reduce your benefits to meet that line.
How to Make Sure Your Worker’s Comp Claim Isn’t Rejected
For some workers, the difference between receiving benefits or getting rejected can have a serious impact on their lives. If this sounds like you, then following these tips can help improve your chances of getting your claim approved and reduce the risk of getting lost in the worker’s comp claim process.
1) Don’t Wait Too Long to Report the Injury
Once you are injured at work, you only have a limited amount of time to file a worker’s compensation claim. In Ohio, the statute of limitations is 2 years from the date of injury or from when you first became aware of the injury. However, there is almost no situation where you should ever wait this long to file a claim. An insurer may question why you waited so long to notify someone or they could reject your claim.
Furthermore, most employers have a policy in place that requires workers to notify their supervisor of injuries sustained immediately. While filing for worker’s comp is not required, notifying your employer probably is. If you violate your employer’s policy, they could terminate you.
If you’ve been hurt, report the injury to your supervisor immediately. For those who plan to file a work injury claim, make sure to do so as soon as possible.
2) Keep Proper Documentation
When it comes to work accident law, proper documentation is your friend. Insurers will want to see proof of your injury and costs associated with treatment. You should maintain accurate notes for everything related to your injury. Even if you don’t plan on filing a claim at the time, these notes can prove to be useful later.
You should also keep a call log of every person you spoke to along with the time, date, and summary of the interaction. Ask your doctor for medical records and keep them in a safe place.
In addition, most employers will require you to fill out a report describing your injury and the incident that caused it. Make sure to fill it out accurately and keep a copy of it for your records.
Injured workers who don’t keep records of their injury will often receive reduced benefits or are rejected entirely.
3) Seek Medical Attention
If you were hurt at work, seek medical attention immediately. Even if the injury is minor and you feel that you don’t need a doctor, you should go anyway to establish medical proof that you were injured. This is one of the single most important steps of any worker’s compensation claim.
If you do not see a doctor then insurers will question the validity of your claim.
4) Do Not Allow for Gaps in Medical Treatment
One mistake often made by injured workers is that they allow for long gaps of time where they don’t receive treatment. For example, if your doctor recommends physical therapy every week and you begin skipping weeks, the insurer may not take your injury seriously and will use your delinquency to reduce or cancel your benefits.
5) Be Careful What You Say to Insurers
The friendly workmen’s comp insurer on the other end of the phone may seem like they want to help you, but they do have a job to perform. Insurers are required to be on the lookout for inconsistencies in your statements to prevent insurance fraud. Even if you’re being honest, not exercising caution on what you say to the insurance representative could cost you your claim.
Always assume that your calls are being recorded and do not provide more information than what they need. If they ask a yes or no question, reply as such – you don’t always need to explain your answer to them. And in some cases, it’s best to avoid answering them altogether.
For example, the insurer may want to know more about your diagnosis, medical treatment, and prognosis. In these situations, it’s best to refer them to your medical doctor or workers comp lawyer.
6) Carefully Sign Documents
Most people are oblivious to the documents they sign. After all, who wants to read a bunch of pages filled with legal jargon? However, injured workers should exercise extreme caution when asked to sign any type of document regarding their accident or claim.
Your signature is considered a legal authorization and you can be held accountable for documents that you sign. For example, insurers may ask you to sign a medical authorization form that grants them access to your entire medical history. This is a massive breach of privacy and often provides insurers unlimited access to what could be very personal medical information. Plus, they could reduce or reject your benefits by blaming it on a previous injury you had.
If you’re having trouble understanding the document, bring it to a workers compensation lawyer for guidance.
Are You Settling for Enough?
Once you’ve reached maximum medical improvement (MMI), you may be eligible for a lump sum settlement. If you choose to settle, your claim will permanently close and you won’t be eligible for any further benefits. While it may be enticing to have a large sum offered to you by the insurers, it’s important to carefully consider your options first.
Will that settlement offer cover all your past, current, and future medical expenses? If you’re partially or permanently disabled, then you’ll need to take into account the future earnings you lost due to the injury.
Unfortunately, most workers accept the initial settlement offer which often will not last through the costs of future medical expenses or diminished work capability.
If your insurer offers you a lump sum settlement, make sure to discuss it with your work accident attorney before accepting it.