Understanding Workers' Compensation

Workers' compensation is an insurance program that provides benefits to employees who sustain injuries or illnesses as a result of their job. In theory, it is meant to cover medical expenses, wage replacement, and disability benefits. However, in practice, some employees face challenges when trying to claim these benefits.

Steps to Take if Denied Workers’ Compensation or Time Off for Recovery:

1. Document Everything:

Write down the details of the injury, how it occurred, and any subsequent actions or conversations with your employer regarding your injury and compensation. Keep records of all medical treatments and any related expenses.

2. Report The Injury:

If you haven’t done so, formally report the injury to your employer. Be sure to follow your employer’s policies and keep a copy of the report for your records.

3. Consult An Attorney:

If your compensation claim is denied or if your employer retaliates against you for filing a claim, it's time to consult an attorney who specializes in workers’ compensation and employment law. As a member of the Tomczak Law Group, I highly recommend seeking legal counsel to discuss the specific details of your case.

4. File a Claim with the Workers’ Compensation Board:

Your attorney will help you file a formal claim with the state workers’ compensation board.

5. Collect Evidence:

Collect all evidence related to your injury, including witness statements, surveillance footage, and medical records. This will strengthen your case.

6. Prepare for Hearings:

If necessary, prepare for hearings before the workers’ compensation board. Your attorney will guide you through this process.

Common Mistakes to Avoid:

As you navigate the workers’ compensation process, there are common pitfalls that you should be aware of:

1. Not Reporting the Injury in Time:

There is often a time limit within which you must report an injury. Make sure you report your injury as soon as possible.

2. Not Following Medical Advice:

If you are not compliant with your medical treatment, it could be used against you to claim that you are not seriously injured.

3. Using Social Media:

Be cautious about what you post on social media. The opposing side might use your posts to argue that your injury is not as severe as you claim.

4. Settling Too Early:

Do not accept an initial offer without consulting an attorney, as it might not fully compensate you for your injuries.

Employer Retaliation – What You Need to Know:

Employer retaliation for filing a workers’ compensation claim is illegal. Retaliation can include termination, demotion, or any adverse employment action.

If you believe your employer is retaliating against you for filing a claim, document the retaliation and consult an attorney immediately.

What if My Employer Doesn't Have Workers’ Compensation Insurance?

It's required by law in most states for employers to have workers’ compensation insurance. If your employer doesn't have it, they may be liable for paying out of pocket for your injuries. Consult an attorney to discuss possible avenues for compensation.

Reasons Your Claim Might Be Denied

It’s essential to recognize that not all workers' compensation claims are approved. There are several reasons your claim might be denied. According to a Lockton study mentioned in a 2020 article by Tom Jackson, employers and insurance companies often dispute and deny claims in hopes of saving money.

In the words of Dean V. Dominick, a York, PA attorney quoted in the same article, “Unfortunately, not every employer adheres to their legal responsibility to provide workers’ compensation benefits.” He goes on to explain that some employers “will often take advantage of unrepresented employees, using their unfamiliarity with the law to save money.”

It is also crucial to understand that claims can be denied either in whole or in part. Jang, another expert cited in the article, warns employees not to assume income benefits will be awarded just because an injury is sustained at work that would normally be covered. The key message here is that insurers have a vested interest in not paying out, and employers often don't want to see their premiums increase. Therefore, they actively look for opportunities to invalidate claims.

Common Disputes and Challenges by Employers

Understanding the common disputes and challenges employers may raise against your workers’ compensation claim can help you be better prepared. Here are some typical objections and how to address them:

1. Employer Disputes the Details of Your Claim:

Employers might argue that the details in your report are inaccurate or that you weren’t at work when you were injured. Also, insurance companies often have investigators to check the legitimacy of the claims. It’s vital to maintain consistency in your account of the incident and ensure it aligns with medical records.

2. Questioning the Relation of the Injury to Work:

If an employer argues that your injury isn’t work-related, it can complicate your claim. For instance, injuries during a typical commute or lunch breaks are usually not covered unless you were on an errand for the company. It’s essential to demonstrate that you were acting within the “course and scope” of your employment when the injury occurred.

3. Claiming the Injury is Not Compensable:

Different states have various criteria for what injuries are covered by workers’ compensation. Ensure that your injury or illness is covered under your state’s laws. For example, some states allow claims for psychological stress, while others do not.

4. Lack of Medical Care:

Not seeking medical attention for your injury can be a detriment to your claim. It's vital to receive medical care to establish the severity and nature of your injury.

5. Treatment by an Unapproved Doctor:

Most workers' compensation systems require that you see a doctor from an approved list. Even though there could be concerns regarding the impartiality of approved physicians, seeking treatment outside the network can lead to your claim being denied.

6. Pre-Existing Conditions:

If you have a pre-existing condition, employers might argue that the workplace injury only aggravated it and is not entirely new. Understanding how your state handles pre-existing conditions is crucial.

7. Termination of Employment before Claim Filing:

Filing a claim after being terminated, laid off, or quitting might cause the employer to dispute its legitimacy. It’s essential to file your claim promptly.

8. Refusing to Provide a Recorded Statement:

While not required, refusing to provide a recorded statement when asked by the insurer can be used as a reason to deny or delay benefits. It’s best to consult an attorney before making this decision.

9. Lack of Witnesses:

If no one witnessed your injury, it might be easier for the employer to dispute your claim. Ensure that you report your injury to coworkers and supervisors immediately and consistently.

Citing Workers Compensation Experts for Informed Guidance

(Last Updated: June 17, 2020 / Author: Tom Jackson)

The information presented in this article has been sourced from Workers Compensation Experts.

We cite this reputable source to enhance workers' understanding and offer valuable insights to those seeking guidance in workers' compensation matters.

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Why Professional Representation Matters

If your claim is denied, or if you believe you are being treated unfairly by your employer or the insurance company, it is vital to seek professional legal representation. Attorneys experienced in workers' compensation can help navigate the complex legal landscape, ensure that your rights are protected, and assist you in receiving the compensation you deserve.

Attorney Dean V. Dominick warns that employers may take advantage of unrepresented employees, using their unfamiliarity with the law to save money. Additionally, having an attorney can help you deal with the network of doctors and ensure you receive proper treatment.

How Can Tomczak Law Group Help You?

If you are facing any of the challenges mentioned above or believe that your rights are being violated, don’t hesitate to reach out to me, Robert Bodach, at Tomczak Law Group. Our experienced team will help you navigate the complexities of workers' compensation claims and ensure that you are well-represented throughout the process.

Don’t take chances with your health and financial well-being. Call us at (815) 723-4400 or Contact us at Tomczak Law Group for a free consultation today!

Conclusion

Dealing with a workplace injury can be overwhelming, especially if you face resistance from your employer or the insurance company. It’s essential to act quickly, document everything, and seek professional legal advice if necessary. Remember, workers' compensation is a right, not a privilege, and you deserve fair treatment and the benefits that are rightfully yours.

Work Cited:

Workers Compensation Experts. What to Do When You Are Denied Workers Comp." Last Updated: June 17, 2020.

Accessed from: What to Do When You Are Denied Workers Comp

Workers Compensation Experts. Accessed from: Workers Compensation Experts

We would like to express our gratitude to Workers Compensation Experts for providing valuable information and raising awareness about important issues related to workers' compensation.

Their expertise and insights have greatly contributed to the knowledge and understanding of workers' rights and the challenges they may face.

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