Tips for handling workers’ compensation claims

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If your client suffered a work-related injury or illness, they may be entitled to workers’ compensation benefits that may cover the following:

Unfortunately, workers’ compensation claims — even legitimate ones — can be unjustly denied by insurers. As a lawyer, there are many things you can do to tilt the scales in your client’s favor.

Insufficient medical evidence is the top reason for the denial of workers’ compensation claims.

Ensure timely reporting of injury and filing of claim

Every US state requires employees to meet certain deadlines when reporting work-related injury or illness and filing workers’ compensation claim forms. Employees in California, for example, should report the accident to their employer in writing within 30 days and file their claim within one year from the time of the accident. If your client misses the deadlines, they may lose their right to collect workers’ compensation benefits.

Ensure prompt medical treatment

Your client should seek medical treatment as soon as possible after the accident. Otherwise, the insurer could argue that your client was not as seriously injured or ill as reported or that the injury or illness did not happen at all.

Getting immediate medical care will also produce important medical evidence that will support your client’s claim, as it describes your client’s injuries or illness and physical restrictions.

Understand the details of your client’s insurance

Workers’ compensation insurances vary among states, industries, company size, and employers. For example, some states require businesses to provide the insurance exclusively through a state fund, while other states also allow self-insurance and private insurance. Most Arkansas employers are only required to provide the insurance if they have three or more employees, but it’s only one employee for most California employers.

Some workers’ compensation insurances cover only medical treatment expenses, while others also provide short- and long-term disability benefits.

By understanding the insurance details specific to your client’s case, you will be able to know if your client is eligible for compensation benefits. If they are indeed eligible, you’ll be able to determine the type of benefits they can get and how much they can expect to receive. You will also know which insurer to contact (e.g., state insurer, private insurer) so you can start learning that insurer’s requirements and procedures for filing a claim.

Consider changing healthcare providers

In many states, the employee must be initially treated by a doctor chosen by the insurer. The problem with working with the insurer’s doctor is that there is a potential conflict of interest. The doctor is primarily paid by the insurer; therefore, they may not have your client’s best interests in mind. For example, the doctor may minimize your client’s injuries so that the insurer won’t have to pay your client as much.

Since the treating doctor plays a crucial role in any workers’ compensation case, it may be more favorable for your client to switch doctors. If this option is available, make sure to check the state’s rules and procedures for changing doctors, as these vary from state to state.

Have strong documentation

Insufficient medical evidence is the top reason for the denial of workers’ compensation claims. This is why you should keep copies of all paperwork related to your client’s workers’ compensation benefits claim, such as:

  • Written and signed accident report
  • Written and signed witness accounts of the accident
  • Pictures and/or diagrams of the location of the accident
  • Written and signed testimony from a vocational expert regarding the job’s physical requirements
  • Medical records assessing your client’s injuries/illnesses and documenting your client’s treatment
  • Work restriction slip issued by the treating doctor
  • Related medical bills
  • Client’s medical history
  • Written and signed statements from friends and family members regarding your client’s daily activities
  • Company policies, workplace safety measures, and employee training related to the case

Related article: The role of medical records in workers’ compensation claims

By having a well-documented claim, your client will have better chances of receiving their workers’ compensation benefits. The problem, however, is that obtaining all relevant medical documents can be difficult and time-consuming. Fortunately, you can outsource that task to Record Retrieval Solutions.

We have provided hundreds of lawyers and law firms with quick and easy access to complete medical records. This way, they are able to get rid of tedious, non-billable tasks and spend more time engaged in more valuable work. Contact us today to get started!

About The Author

img Chuck Dart
Chuck Dart started in the record retrieval business three decades ago. As the industry evolved from analog to digital, he recognized an opportunity to create a single, simple online solution that standardizes the record request and retrieval process across the entire healthcare industry.