When injured on the job as an employee, you will rely on workers’ compensation insurance to cover damages, such as your medical bills. However, the insurance company may not make this process easy for you. It may use several workers’ comp delay tactics to deny or reduce your claim. These tactics include a lack of communication, slow claim processing, and payment delays. Knowing these tactics can help you prepare for any outcomes.
How Does the Workers’ Compensation Process Work?
Workers’ compensation insurance covers expenses and losses suffered by employees after sustaining a work-related illness or injury. It can help cater to an employee’s medical expenses when injured or ill. Lost wages are also among the benefits you can recoup from the program.
The first step in the workers’ compensation process involves an eligible injury or illness occurring at work. The injuries or illnesses must be directly linked to the job to qualify for compensation. Those caused by alcohol or drug use and self-inflicted harm are exempted from the benefits.
Once you sustain an injury or fall sick, it is advisable to seek urgent medical care. The healthcare provider will need to know whether the injury or illness is related to work for documentation purposes. You may also have to pay the bills out-of-pocket and get reimbursed later if your workers’ compensation claim is approved.
Besides seeking treatment, you will need to report the injury or illness to your employer and file a claim with the help of a lawyer. You risk losing out on the benefits if you do it late.
Once you file the claim, the insurance company will start investigating it. The investigation will help it decide whether to deny or approve your claim. The workers’ comp insurance investigation involves reviewing supporting documents and interviewing you and your employer.
If the insurer approves the claim, you will receive payments for your expenses. The amount and type of benefits will depend on the coverage limits and the contents of your claim.
What Does Workers’ Compensation Cover?
Workers’ compensation plans vary with the insurance company or the coverage limits. However, a typical plan will cover injuries, such as falls, trips, or slips at work.
Work-related repetitive stress injuries due to overuse and repeated actions are also covered. You may suffer these injuries from activities such as lifting boxes, sitting for too long, or working in a manufacturing plant.
Your workers’ compensation benefits may cover legal fees, missed wages, and ongoing care. They may also cover expenses incurred from treating illnesses from working with allergens or harmful chemicals in a poorly ventilated area.
If your loved one passes on due to a fatal work-related injury or illness, the insurance plan may cover his or her death benefits and funeral costs. The plan may also offer disability benefits to those who get disabled at work.
Will Late Filing Cause Delays in Processing?
Since you need to recover from your illness or injury and return to work, filing a workers’ compensation claim on time is advisable. If you wait too long to do it, your claim may be denied.
Injured workers in Illinois have 45 days after sustaining an injury to report it to their employers. It will be reasonable to argue that the injury is work-related within this period.
The statute of limitations dictates the time limits injured workers must file a workers’ compensation claim within. In Illinois, you have three years from when you suffered the injury or illness to initiate a workers’ comp claim. The time limit is also two years from the last date you had a medical bill paid by someone else or received a disability check.
Why Would You Wait to File the Claim?
Some injured workers hesitate to file a claim after getting informed that they do not qualify for the benefits due to their employment status and the nature of the injury. It is also common for people to be coerced or shorted out of the benefits because their insurer or employer gives them misleading or incomplete information about their benefits. Consulting with a lawyer can help confirm whether the information is reliable.
You may also take time to file the claim if you have a pre-existing injury (which is difficult to tell without a diagnosis) or sustain a repetitive stress injury. A repetitive stress injury, such as arthritis, may take a while before interfering with your work. In this case, the statute of limitations will begin when you get diagnosed with the injury.
The Common Types of Delay Tactics Used by Workers’ Compensation Insurers
Out-of-pocket medical expenses for a work-related injury or illness are usually costly. The injury or illness will significantly affect your finances and well-being. As you try to recoup your losses by filing a claim, watch out for the following workers’ comp delay tactics used by insurers and employers:
Slow Claims Processing
The insurance company may intentionally try to slow down the administrative protocols in the claims process. Through a representative, the company may ask you to fill and submit unnecessary forms or request additional documentation.
These tasks are quite tiring for an injured worker, whose hope is to receive the benefits and return to his or her normal life. Insurers use this delay tactic to discourage or intimidate victims from actively pursuing the claim. Luckily, a workers’ compensation lawyer can help you spot this tactic and present defenses against it.
Your employer may have a part in this delay tactic. The employer may ask you to leave the claim to him or her. If you fail to follow up, the employer will put your claim on hold for too long.
Lack of Communication
Workers’ compensation claims require constant communication with the workers’ comp adjuster. If the adjuster intentionally tries to refrain from speaking with you, the adjuster may interfere with the claims process.
The insurance adjuster may decide not to respond to your emails or calls. As a result, you may miss crucial deadlines and take additional time to resolve the case.
Insurance adjusters only focus on protecting the interests of their insurance companies. Keep records of all forms of communication (or lack of communication) and stay organized to protect yourself from insurance company delay tactics. Your lawyer can use these pieces of evidence to prove that the adjuster was unresponsive and using bad faith insurance practices.
Disputing the Injuries or Failing to Authorize Treatment
The insurance adjuster may try to downplay or dispute the nature of your injuries as a delay tactic. The adjuster may ask you to undergo several medical examinations to confirm whether the injury is severe. You can also expect the adjuster to claim that the injury was self-inflicted or caused by a pre-existing condition or a non-work-related event.
Through an adjuster, the insurer may also fail to authorize treatment. This is a common occurrence even when you have medical records to prove that the injury or illness is work-related. These tactics usually aim at discrediting the doctor’s findings. If they prevail in your case, they may cause delays in the claims process.
Delaying the Payment or Avoiding It
It should take a short time to receive the payment once an insurance company approves your workers’ compensation claim. But if it takes longer, the insurer may be trying to make the process difficult for you.
The insurance adjuster may tell you he or she is still waiting for the insurance company to send an authorization form. The adjuster may also claim the company lacks enough funds to compensate you.
It is also common for the insurer to give you less compensation than what your claim is worth. Expect the company to say that some treatments sought for your injuries are not covered under the insurance plan or are not necessary.
Asking for a Recorded Statement
Giving a recorded statement to the insurance company without your lawyer’s approval can harm your case. The workers’ compensation adjuster may use the statement against you to downplay or deny your claim. The adjuster will look for admissions of fault or inconsistencies in the statement, or manipulate it to suit his or her agenda.
Before giving the statement, you should remember that insurance adjusters do not consider your best interests. They focus on helping insurance companies avoid paying huge sums of money as compensation. Speak to your lawyer about the pros and cons of giving a recorded statement. You can avoid giving it altogether if it will jeopardize your case.
Offering a Light-Duty Job
Your employer may ask you to take on light-duty tasks at work as you recover from the injury or illness. Accepting this offer may prove your willingness to work and help you earn income. However, if your workers’ compensation benefits are still pending, this decision can harm your case.
The insurance adjuster may claim your injuries were not severe since you agreed to return to work. If this argument works in the adjuster’s favor, you may get reduced benefits or lose the compensation altogether.
Take time to heal before returning to work. The injury or illness may prevent you from doing some tasks at work safely. It may also get worse or leave you permanently impaired.