When Things Go Wrong With Your Workers' Comp Insurance

Posted on: 27 April 2020


When it comes to work-related injuries and illnesses, few things beat workers' compensation insurance. This insurance comes to workers free of charge and covers them from the very first moment they begin working. Most workers never think about this form of coverage until they are hurt on the job. In most cases, benefits are paid. In others, not so much. Read on and find out what can go wrong and how to make things right again with your workers' compensation insurance claim.

What to Expect When the Claim is Approved

When your claim is approved, the benefits are pretty good. You get covered for all of your medical expenses. You can stay home and recuperate but your normal salary is not paid. Instead, disability wages are paid at approximately 66.6% of your usual salary. The exact percentage can vary by state. Later on, if you are found to have a permanent injury, you may also be paid a lump-sum settlement.

What to Expect When You Have Problems With the Claim

The first indication of problems with your claim might come with a denial letter in the mail. Take a good look at the reason cited in the letter for the denial and see if you can handle it with a phone call to the employer or the insurer. There might be an error on the claim form or the insurer might need clarification, for example. Workers' comp accident claim forms are often confusing and difficult to properly fill out. If you have been denied for other reasons, however, you may have more of a challenge in front of you. Some common and more serious issues can include:

  • Allegations that your accident or illness is not work-related.
  • Problems with preexisting conditions.
  • Accusations of using illegal substances.

For more serious issues with your claim, you may need the help of a workers' compensation attorney.

Appeals and Mediation Procedures

You are entitled to appeal any negative rulings and the instructions are usually contained in the denial letter. Be sure not to miss the deadline for requesting the appeal. Even if you think you can resolve the issue without an appeal hearing, file the request for the appeal before the deadline occurs.

If you proceed with the appeal, you can expect to also participate in mediation. Mediation attempts to resolve issues about the claim without having to go to an administrative hearing. If you are able to make an agreement with the workers' compensation carrier, it's put in writing and becomes a legal document. If not, you and your lawyer will proceed to the last step, the administrative hearing.

At the administrative hearing, you will be glad to have legal representation. These hearings can be intimidating and stressful for hurt workers who are on their own. You can expect to see actions that remind you of a lot of a court proceeding. Don't go through any of this alone. Talk to a workers' comp lawyer about your denial right away.