Once an employee has notified his or her employer of a workplace injury, it becomes the responsibility of the employer’s insurer to investigate the claim. The insurance company will then either approve or deny the workers’ compensation claim.
While some employers are self-insured, most prefer to purchase coverage from private workers’ compensation insurance company that has the resources and expertise to handle these sorts of complicated claims.
Unfortunately, insurers do not always make the claim filing process easy for injured employees. The insurance companies often take their time with each claim and for an injured worker, it seems like the insurance firm is dragging their feet when processing a claim.
Once an injury is reported, an insurance firm has an obligation to research the claim. Insurers are required to suits certain deadlines during their investigation. If you were injured at work, and you reported your injury but it seems like your claim is taking too long you should speak with an experienced workers’ compensation attorney who can confirm that insurers abide by the principles.
Processing Delays
Processing delays are one of the foremost common ways in which insurers make the claim filing process difficult for injured employees. Investigations require paperwork and people and time, all of which combine to make it so that a worker’s compensation claim moves at speeds glaciers can sometimes match.
In many cases, these delays are the result of honest mistakes like filing or clerical error. Others can be errors attributed to the injured worker if he or she failed to turn in the correct paperwork, did not include supporting documentation, such as medical records, or made an error when filling out the required forms. In fact, errors on paperwork handled by the person injured on the job are the most common reason for delayed processing of a workers’ compensation claim.
That’s why a skilled workers’ compensation attorney is so helpful to people who have been hurt at work. Workers’ compensation lawyers can be sure to avoid any filing or clerical errors when working on behalf of their clients. Be wary. Some processing delays can't be chalked up to errors on the part of the injured worker. Instead, some are the result of more serious problems with a company’s filing and investigation processes. Three typical causes of delays by insurance companies are:
- Workers’ compensation law is consistently evolving and insurers who don't track these changes and alter their procedures to account for them take for much longer to process claims and award benefits.
- Another problem faced by insurers is understaffing. In fact, many delays are merely the result of an insurance adjuster’s inability to handle an overburdened caseload.
- And finally, the claims of injured workers are often delayed due to an insurer’s attempt to convince a claimant to accept a lower settlement in lieu of regular payments. Unfortunately, this tactic is successful in many cases, as injured employees find themselves facing mounting medical bills, a drag that's only compounded by the employee’s inability to figure.
In Pennsylvania, using these tactics is against the law. In fact, insurers are required to end processing a claim within 1 month of being notified about the injury, and people who aren't ready to provide an inexpensive explanation for the delay in processing or investigating a claim are often required to pay damages to the injured worker.
Some Pennsylvania courts have even required insurers to pay claimants as much as 50% of the amount that they should have received in benefits, in addition to lost wages and compensation for medical expenses. It takes a workers’ compensation lawyer fighting for your rights to successfully prove a criminal delay in processing by an insurance firm.
Unfair Denials
Workers’ compensation insurers are primarily responsible for investigating and then either approving or denying a claim for benefits. If a claim is accepted, the insurer must begin paying benefits immediately.
Unfortunately, valid claims are denied on a regular basis.
Some insurers argue that an injury doesn't qualify as a disability or that the worker wasn't technically “on the job” when the accident occurred. In other cases, the insurer will try to pass off liability to a third party rather than award workers’ compensation benefits.
If you feel you’ve been given an unfair denial of a workers’ compensation claim, the only way to undo the denial is in court. You’re going to need a lawyer. The litigation process for unfair denials is complex and difficult.
In court, lawyers have to produce evidence to support the argument that the injured worker was entitled to the benefits. To convince a judge that the insurer unfairly denied benefits, one must come prepared with supporting documentation, such as medical records and the testimony of eyewitnesses.
Injured workers are also much more likely to be successful if they file an appeal earlier rather than later. This is why it’s so important to get the help of a fanatical attorney who is well-versed in state law and may make sure that the appeal is filed correctly and on time.
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