When you get injured on the job, you want to collect your workers’ compensation benefits as soon as possible. You need the money to support your family and help with your medical bills. Unfortunately, insurance companies often make quick collection of benefits difficult.

    Unless your employer is self-insured, which is not common, workers’ compensation benefits are paid out through health insurance companies, which have experience dealing with complicated claims such as workers’ compensation.

    These companies don’t necessarily want to pay you, as doing so puts them at a loss. It’s in their own best interest not to give you this money. They may try to poke holes in your workers’ compensation case by proving you were not injured on the job or showing that your injury isn’t as severe as you claim. This process does not reflect on your trustworthiness or honesty. Insurance companies want to find loopholes so that they won’t have to pay, making the process more difficult for you.

    Insurer Responsibilities During Workers’ Comp Cases

    Once you’ve filed your workers’ compensation claim with your company, your case gets turned over to the insurance company. This company has a number of responsibilities as your case moves forward, including:

    • Confirming that you’re covered under your employer’s plan
    • Looking into and investigating your claim
    • Authorizing medical treatment
    • Providing billing and reporting instructions to your health care provider
    • Determining whether to pay wage compensation and medical fees
    • Denying or delaying benefits, if necessary

    How Insurers Can Make the Workers’ Compensation Process Harder

    The longest part of your case likely will be the investigation. First, the insurance company determines the basics of the case, finding out where the injury occurred, what the circumstances surrounding it were and how severe it is.

    RELATED RESOURCE  What Is a Functional Capacity Exam (FCE)

    Next, it investigates important issues that will determine whether your case is eligible for benefits. The most critical factor is whether your injury occurred on the job. They also want to know if the injury is as severe as you say it is.

    The insurance company will talk to a number of people during the investigation. Someone from the company will likely review your medical records or even interview your physician, your supervisor and any witnesses to the accident. They’ll also want to speak with you. They’ll ask a lot of questions, and they may try to put words in your mouth to describe your injury or the accident.

    Investigations can draw out for a long time. Other things the insurance company may do to delay approving your benefits include:

    • Hiring a private investigator to put you under surveillance
    • Reading your social media posts or the posts of your family and friends
    • Implementing process delays
    • Unfairly denying a claim

    An experienced attorney can help you deal with the insurance company and any delays you may encounter in your workers’ compensation case. Frommer D’Amico can assist you. We handle only workers’ comp cases for employees, and we charge low fees. We’ll come to your location for meetings too. Contact us today at 717-400-1000 or get in touch online.

    Share:

    Comments are closed.