If you’re injured at your place of work, workers’ compensation insurance usually covers related expenses, like medical bills. However, navigating the compensation process isn’t always straightforward. This is because insurance companies often use workers’ comp delay tactics to try to avoid paying claims or diminish their severity. Common strategies include sluggish claim processing, poor communication, and delayed payments.
Continue reading to learn more about tricky ways insurance adjusters avoid paying workers’ comp claims. Our attorneys want to equip you with knowledge on how to best overcome these hurdles.
Understanding the Workers’ Compensation Claim Process
Workers’ compensation insurance is intended to cover expenses and losses incurred by employees as a result of workplace injuries or illnesses. It’s a resource for covering an employee’s medical costs and can also compensate for lost wages.
The workers’ comp process begins when a work-related injury or illness occurs. To qualify for compensation, the injury or illness must be directly connected to work activities.
It’s vital to seek immediate medical attention following an injury or the onset of an illness. You must inform a professional healthcare provider of the work-related nature of your condition for documentation purposes. Initial medical expenses might require out-of-pocket payments, which can be reimbursed upon claim approval.
You must also report the incident to your employer and initiate a claim as soon as possible. You may want to enlist the assistance of a qualified workers’ comp attorney in Rockford, IL. Late reporting and delayed claim initiation could result in a forfeit of benefits.
Once the claim is filed, the insurance company will initiate an investigation aimed at determining your eligibility. This involves a review of supporting evidence and discussions with you and your employer. If your claim is approved, you will receive compensation for your reported expenses. Your benefit amount and what is covered will be determined by the specifics of your policy.
Coverage Scope of Workers’ Compensation
Workers’ compensation insurance covers a variety of injuries, illnesses, and related expenses. These can include, but are not limited to, the following:
- Trips, slips, and falls on the job
- Work-related repetitive stress injuries (arising from overuse or repeated actions)
- Burns
- Lacerations
- Puncture Wounds
- Bone fractures
- Lost wages
- Ongoing care
- Legal fees
- Medical expenses
- Disability benefits
In unfortunate circumstances of fatal work-related injuries or illnesses, insurance may cover death benefits and funeral costs.
Don’t Delay Filing Your Claim
Timely filing of a workers’ compensation claim is crucial for a swift recovery and return to work.
In Illinois, injured workers have a 45-day window to report an injury to their employers. The deadline for filing a workers’ compensation claim is as follows:
- 3 years from the date of injury or illness
- Or, 2 years from the date of last received benefits for said injury/illness
Some workers might delay filing due to misinformation regarding their eligibility. This often comes in the form of misleading or incomplete information from their insurer or employer.
Delays might also occur if a pre-existing injury or a repetitive stress injury is involved. For instance, conditions like arthritis may take time to manifest, with the statute of limitations starting upon diagnosis.
Delay Tactics Used by Workers’ Compensation Insurance Companies
The financial burden of out-of-pocket expenses for work-related injuries or illnesses can be daunting. While striving to obtain the benefits you’re entitled to, be aware of the following delay tactics used by insurance carriers.
- Slow Claims Processing: Insurance companies might intentionally stall claim processing. This could involve asking you to complete excessive paperwork or provide additional documentation. Your employer might also contribute to the delay by promising to handle the claim, only to put it off indefinitely.
- Insurance Company Is Not Responding: Continuous communication with the workers’ comp adjuster is vital. Lack of communication can hamper the claims process, leading to missed deadlines or an extended resolution time.
- Keeping a record of all communication attempts is advisable when you’re fighting for workers’ comp. Not responding to emails and phone calls is a clear sign the adjuster isn’t doing their job.
- Disputing Injuries or Denying Treatment Authorization: Adjusters may try to trivialize or dispute your injuries to delay your claim. They may request repeated medical evaluations in an effort to accomplish this.
- An insurer may also argue that an injury was self-inflicted, or arose from pre-existing conditions or non-work-related activities. They may withhold treatment authorization despite having medical documentation linking the injury or illness to work.
- When you’re filing for workers comp’, delayed treatment could result in your condition worsening and long-term impairment. There should be no disputes from the insurance company regarding medical treatment prescribed by your doctor.
- Payment Delays: Once a claim is approved, payment should follow promptly. However, an adjuster might claim they’re awaiting authorization or allege insufficient funds for compensation. They might also offer less compensation than the claim’s worth, arguing that certain treatments are either not covered or unnecessary.
- Request for A Recorded Statement: Providing a recorded statement to the insurance company without legal counsel can be detrimental. Adjusters might exploit the statement to undermine or deny your claim.
- Offer of A Light-Duty Job: Your employer might suggest a light-duty job during your recovery. While this might demonstrate your willingness to work and provide some income, it could adversely affect your pending workers’ compensation benefits. Adjusters might argue that your acceptance indicates your injuries were not severe, which could lead to reduced benefits or claim denial.
Contact Our Trusted Workers’ Compensation Lawyers
Getting injured on the job can leave you and your family in jeopardy. Without any financial income, everyday expenses, costly medical bills, and the potential need for long-term care can feel overwhelming. Fortunately, our legal team is here to support you during this difficult time.
If you’re struggling to file a workers’ compensation claim or you haven’t received your benefits, contact The Crosby Law Firm. Our highly skilled workers’ comp lawyers in Rockford will fight to help you get the benefits you deserve.
Contact us today to schedule a free initial consultation.
