What NOT To Do: Common Mistakes That Lead to Denied Workers’ Comp Claims
According to a recent research study, approximately 7% of all workers’ compensation claims are initially denied. While some denials make sense, others are issued as a result of avoidable mistakes and miscommunications.
Thankfully, the team at Rocky McElhaney Law Firm knows a thing or two about what works – and what does not – when filing a workers’ compensation claim. Here are some common mistakes that may result in claim denials, and an explanation of how to avoid inadvertently derailing your fight for compensation.
Why workers’ comp claims are denied
In Tennessee alone, there are tens of thousands of workers’ compensation claims filed every single year. While we all hope that our workers’ compensation benefits will be paid out fairly and promptly in the event of a workplace accident, the unfortunate truth is that many workers have their claims denied while attempting to recover from their injuries.
Claim denials can be attributed to a wide variety of qualification issues and clerical errors, so it is important to understand what NOT to do when attempting to file a workers’ compensation claim.
Here are nine common mistakes employees make when filing for workers’ compensation:
1. They wait too long to file a claim.
In Tennessee, you are typically required to report your injury to your employer within 15 days if you are hoping to receive workers’ compensation. If you fail to report your injury within the allotted time frame, your claim may be denied, delayed, or otherwise complicated. The sooner you report your injuries, the sooner you can get the ball rolling on your claim.
And remember: you should always make a written report rather than relying on a verbal complaint alone. Accurate documentation plays a central role in most workers’ compensation claims, so it is important for you to keep a comprehensive paper trail of documents related to your accident, starting with your incident report.
2. They ignore or downplay their symptoms
It might be tempting to ignore or downplay certain workplace injuries in order to avoid using paid time off or spending their own money on doctors’ visits. Unfortunately, shrugging off an accident can actually backfire and lead to serious complications down the line. The extent of many injuries may not be evident immediately after an accident, and symptoms may develop or worsen over time.
If you do not take steps to address any potential health concerns promptly after an accident, you may compromise the validity of your claim or the total of your future payout. You should seek medical attention as soon as possible after an accident in order to protect your health and document the relationship between your accident and your injuries.
3. They visit out-of-network providers
As with most health insurance policies, it is important to visit an in-network provider when attempting to use workers’ compensation insurance benefits. Visiting a doctor who is not in one of the options approved by your employer may result in coverage denial or limitations. Even a single visit outside the network can raise red flags and limit your ability to receive and pay for care.
You should always attempt to see one of the providers recommended or authorized by your employer’s workers’ comp plan to limit the potential for denied or delayed benefits. If you are not sure if a particular provider or facility is covered, ask your HR department or attorney before seeking care.
4. They submit incomplete or inadequate paperwork
As we mentioned, accurate and comprehensive documentation is one of the most important components of a successful workers’ compensation claim. Missing claim forms, incomplete employer reports, or paperwork that fails to include important details like date, time, or medical prognosis can kill your claim before it starts. Even if it feels like overkill, you should always err on the side of providing too much documentation rather than too little.
You should include copies of any and all documentation outlining the relationship between your workplace accident and your current symptoms when filing a claim, and retain copies of anything you submit. It can be helpful to work with an experienced workers’ compensation attorney while filing a claim to ensure that your paperwork is accurate and comprehensive enough to be considered.
5. They do not follow their doctors’ orders
Some injured employees find themselves eager to return to “normal” after an accident and may subsequently cut corners regarding their care. If your doctor recommends physical therapy, specialized treatment, or physical restrictions and you do not follow their instructions, your employer’s insurer may attempt to deny or undervalue your claim.
Failing to follow through with a provider’s care recommendations may lead an insurer to argue that your injuries were not actually that serious or that your symptoms only worsened or persisted as a result of your lack of care. That is why it is so important to stick to your treatment plan, attend all appointments, follow restrictions, and document any new or worsening symptoms that may arise over the course of your recovery.
6. They say too much
Insurance adjusters, employers, and HR professionals may be inclined to ask you leading questions about your accident and injuries in order to derail your claim. If you provide a recorded statement to an insurer without legal guidance, anything you say can be used against you during the claims process.
You are not required to give a recorded statement without consulting your attorney, and doing so could protect you from making statements that may be used to dispute your claim. Failing to stay tight-lipped about your accident could result in your employer claiming your injuries were not actually severe or did not occur as you described. Playing your cards close to your vest can help you protect your rights and give you time to consult with a trusted workers’ compensation lawyer about your case.
7. They post about their accident on social media
While it might be tempting to post about your workplace accident or resulting injuries, anything you share online can also be used against you. Even social media posts that do not explicitly mention your accident can raise questions about your condition, so it is vital that you watch what you post in the weeks and months following an accident.
For example, if you file a workers’ compensation claim and proceed to share posts online about going for a run, taking an active vacation, or visiting your local gym, your employer and their insurance company may claim your injuries are not serious enough to warrant compensation. To be on the safe side, it is best to put your social media presence on pause while your claim is decided or – if you must post – consult your attorney prior to making anything public.
8. They take “no” for an answer
By now, you are probably aware of the fact that a significant number of workers’ compensation claims are initially denied. However, you should also know that more often than not, denied claims are ultimately paid out as a result of appeals and disputes.
If you file a claim and receive an immediate denial, do not just throw your hands up and walk away. An experienced workers’ compensation attorney can help you gather additional paperwork, make adjustments to your claim, and navigate the appeal process to help you improve the chances of a payout. Because appeals can get complicated fast, it is always best to partner with a legal professional you can trust to help you maximize the value of your claim without causing you additional strain during your recovery.
Need more help?
Workers’ compensation is meant to support injured employees, not place them under additional stress during times of uncertainty. Unfortunately, many injured employees have their initial claims denied and find themselves struggling to understand why. If you are asking, “What if my workers’ comp claim is denied?”, you are not out of options, and you are certainly not alone. Understanding the nuances of the workers’ comp system can help you avoid common mistakes that result in claim denials while moving forward on your road to recovery.
If you have been denied workers’ compensation and need help deciding what to do next, the team at Rocky McElhaney Law Firm might be able to help. Give us a call today or fill out our online contact form to speak with a member of our team, and let us see what we can do to help you fight for the benefits you deserve after a workplace accident.