60% Of Workers’ Comp Claims Are Denied. Where Do They Go Wrong?

construction worker hurt on job

Since more than half of workers’ comp claims are not approved for payment, something must be going wrong with these claims. Why would the Bureau of Workers’ Compensation deny payment? Where did the claimant go wrong?

Why Are Worker Comp Claims Denied?

Here are the most common mistakes, and how to avoid them.

  1. The claimant waits to report the injury.

If you are injured on the job — or, and this is trickier, if you are gradually getting sick due to conditions on the job — you need to tell your employer right away. The longer you wait, the more trouble you may have getting a claim allowed.

It is best to report the injury right away, if possible, or to report it the next day. Obviously, for a more serious injury, you may not be able to report it right away. In those situations, make sure the injury has been reported as soon as you are medically stable. Make a written statement in which you explain the date and location of the accident, and the type of injury that occurred. Also list any witnesses who may have been with you at the time of injury, or who saw the injury occur. Keep copies of exactly what you sent, and make sure you note the date on which you reported the injury.

  1. The claimant waits to get medical treatment.

Some workers will wait to see if their condition improves before seeking medical attention. Do not make this mistake. Get treatment right away, even if you suspect the pain or discomfort may subside.

Waiting for treatment could not only invalidate your claim. It could make your injury worse, and it could open the door for the employer’s legal team to suggest that the real injury happened at some point other than the on-the-job incident — that the lasting damage was done because medical attention was not sought.

You need a note from a doctor on file for your claim. You cannot get that note unless you seek treatment. Go to your general practitioner, go to an urgent care, go to an emergency room, or go to the health care provider designated by your employer. Some jobs have specific workers’ comp health care that the employer chooses. Other employers have on-site health care. However you can seek medical care, do it immediately after the injury.

  1. The claimant loses the paperwork.

This is self-explanatory. Save all of your papers. Do not assume that your health care providers can reproduce or replace missing receipts and documentation after the fact. Also do not assume that your employer is keeping track of all the paperwork you provide them. Keep a copy of everything.

  1. The claimant tries to settle the case without an attorney.

The employer may want to settle right away. And that may be a perfectly valid option. But before that happens, consult with an attorney. The insurance company will take note if you lack legal representation, and will use that fact to minimize the amount they pay out.

  1. The claimant makes a recorded statement.

Occasionally, an employer representative may conduct an investigation into a potential claim. If you have any doubt as to whether or not you should speak with your employer’s investors, contact an attorney who specializes in workers’ compensation.

  1. The claimant hires an attorney whose specialty is not in workers’ compensation.

You may have a friend who is a lawyer. Or you may have a great relationship with your divorce lawyer, or your copyright attorney. This does not mean that such an attorney will understand workers’ comp law. Workers’ compensation law is a unique area of the law, which does not always translate well from other practice areas. Often, additional training far beyond the typical bar exam is needed in order to be competent in this area. Having a lawyer who lacks this specialized training is like asking your eye doctor to perform open-heart surgery.