Workers’ compensation is a vital safety aspect in most organizations. It offers monetary and emotional support to employees who suffer extreme injuries or death while on duty. However, in some cases, insurers can deny the claim based on the information provided or their compensation criteria. Here are the top reasons workers can miss compensation after filing a claim.
1. Failure To Promptly Report The Injury
Each state has its set deadlines within which a worker can report injuries to be eligible for compensation. Most jurisdictions require injured employees to file the claim within 21 days. However, some allow employees to report to their employers within 120 days or file a case within three years. Failure to report within the timeframe can make the insurance company skeptical about the claim’s legitimacy.
To avoid missing compensation, workers are advised to report the injury as soon as it occurs. That means employees should familiarize themselves with the company’s injury reporting policies. Consulting legal experts such as Hershey workers’ compensation lawyers is essential to help individuals gather relevant information to speed up the process. The attorneys will also advise injured workers along the claim process and represent them in courts during litigation.
2. Insufficient Medical Evidence
A worker may skip medical attention after injury, hoping the condition will subside with time. It is also common for some employees not to trust the company doctor because they feel they will not receive the best medical attention. While they may have legitimate reasons for not seeking an examination, lack of or insufficient medical evidence can cause an insurance company not to warrant compensation. An incomplete medical report can also make the insurer not trust the employee and deny the claim.
Visiting professional healthcare immediately after the incident is essential as it establishes the link between the injury and the workplace. Employees must also follow the treatment plan as prescribed by the doctor and keep all records of the treatments and related bills. The insurer will also assess the record to identify any missing links, which can reduce the benefits or lead to an automatic denial. Injured workers must be honest with the doctor and the information they provide in the claim form.
3. Pre-Existing Medical Conditions
Insurance companies or employees can also deny the claim if they believe the employee had existing conditions before the injury. While the injured worker may prove that the injury is work-related, processing the claim can be challenging, leading to delayed justice. To ensure the process is simple, workers are required to provide their medical history and the link between their injuries and the job they do.
Some duties require workers to disclose their medical conditions before securing the job. This helps employers and insurance companies process claims in case of fatal incidents. Workers who suffer on-site injuries can also seek guidance from experienced personal injury attorneys, who will assist them in proving their claims.
Endnote
Claiming successful workers’ compensation can be challenging, particularly if the individuals need more evidence. The journey involves numerous pitfalls that can be unfavorable to injured individuals, leading to denied or delayed justice. Besides taking prompt action, employees must also work closely with their doctors and attorneys to maximize their benefits.
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