Since more than half of workers’ comp claims are not initially approved for payment, something must be going wrong with these claims. Why would the Bureau of Workers’ Compensation deny payment? Where did the claimants go wrong?
Why Are Worker Comp Claims Denied?
Here are the most common mistakes in initial filings of workers compensation claims in Ohio, 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 approved.
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, and in any case the focus should be on seeking immediate medical treatment for serious injuries. 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, location and circumstances 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.
2. 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 for any type of workplace injury, 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, or that any lasting damage was done because medical attention was not sought immediately.
You need a note and medical records from a doctor on file for your workers compensation injury claim. You cannot get that documentation unless you seek treatment. Go to your general practitioner, go to an urgent care center, go to an emergency room, or go to the health care provider designated by your employer. Some jobs have specific workers’ comp health care providers that the employer chooses, while other employers have on-site health care providers. However you can seek medical care, do it as quickly as possible after the injury so that the extent of the injury can be correlated with the timing of the cause.
3. 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 (although, if you’re missing paperwork, it’s worth checking with your provider to see if they can). Also do not assume that your employer is keeping track of all the paperwork you provide them. Keep a copy of everything.
4. The claimant tries to settle the case without an attorney
Your employer may want to settle right away, before the true extent of your injuries may be revealed, and certainly before it’s known how well you will ultimately heal. In some cases, that may be a perfectly valid option, with no harm to the injured employee. But before you agree to any sort of settlement of a workers compensation claim, 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. An experienced workers comp lawyer will help to protect your long-term interests.
5. The claimant makes a recorded statement
Occasionally, an employer representative may conduct an investigation into a workers comp claim. If you have any doubt as to whether or not you should speak with your employer’s representatives, contact an attorney who specializes in workers’ compensation before you say anything “on the record”.
6. 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 a 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. Get advice from a specialist who knows how to best protect your rights.