How Insurers Make the Workers’ Compensation Process More Difficult

Part Eight: How Insurers Can Make the Workers’ Compensation Process More Difficult

Once an employee has notified his or her employer of a workplace injury, it becomes the responsibility of the employer’s insurer to investigate the claim. The insurance company will then either approve or deny the workers’ compensation claim.


While some employers are self-insured, most choose to purchase coverage from a private workers’ compensation health insurance company that has the resources and expertise to handle these types of complicated claims.


Unfortunately, insurers do not always make the claim filing process easy for injured employees. The insurance companies often take their time with each claim and for an injured worker it feels like the insurance company is dragging their feet when processing a claim.


Once an injury is reported, an insurance company has an obligation to investigate the claim. Insurers are required to comply with certain deadlines during their investigation.


If you were injured at work, and you reported your injury but it seems like your claim is taking too long you should speak with an experienced workers’ compensation attorney who can make sure that insurers abide by the rules.


Processing Delays

Processing delays are one of the most common ways that insurers make the claim filing process difficult for injured employees. Investigations require paperwork and people and time, all of which combine to make it so that a worker’s compensation claim moves at speeds glaciers can sometimes match.


In many cases, these delays are the result of honest mistakes like a filing or clerical error.


Others can be errors attributed to the injured worker, if he or she failed to turn in the correct paperwork, did not include supporting documentation, such as medical records, or made a mistake when filling out the necessary forms.


In fact, errors on paperwork handled by the person injured on the job is the most common reason for delayed processing of a workers’ compensation claim.


That’s why a skilled workers’ compensation attorney is so helpful to people who have been hurt at work. Workers’ compensation lawyers can be sure to avoid any filing or clerical errors when working on behalf of their client.


Be wary. Some processing delays cannot be chalked up to errors on the part of the injured worker. Instead, some are the result of mores serious problems with a company’s filing and investigation processes. Three typical causes of delays by insurance companies are:


  • Workers’ compensation law is constantly evolving and insurers who do not track these changes and alter their procedures to account for them take much longer to process claims and award benefits.
  • Another problem faced by insurers is understaffing. In fact, many delays are merely the result of an insurance adjuster’s inability to handle an overburdened caseload.
  • And finally, the claims of injured workers are often delayed due to an insurer’s attempt to convince a claimant to accept a lower settlement in lieu of regular payments. Unfortunately, this tactic is successful in many cases, as injured employees find themselves facing mounting medical bills, a problem that is only compounded by the employee’s inability to work.


In Pennsylvania, using these tactics is against the law. In fact, insurers are required to finish processing a claim within 1 month of being notified about the injury, and those who are not able to provide a reasonable explanation for the delay in processing or investigating a claim can be required to pay damages to the injured worker.


Some Pennsylvania courts have even required insurers to pay claimants as much as 50% of the amount that they should have received in benefits, in addition to lost wages and compensation for medical expenses.


It takes a workers’ compensation lawyer fighting for your rights to successfully prove a criminal delay in processing by an insurance company.


Unfair Denials

Workers’ compensation insurers are primarily responsible for investigating and then either approving or denying a claim for benefits. If a claim is accepted, the insurer must begin paying benefits immediately.


Unfortunately, valid claims are denied on a regular basis.


Some insurers argue that an injury does not qualify as a disability or that the employee was not technically “on the job” when the accident occurred. In other cases, the insurer will try to pass off liability to a third party rather than award workers’ compensation benefits.


If you feel you’ve been given an unfair denial of a workers’ compensation claim, the only way to undo the denial is in court. You’re going to need a lawyer. The litigation process for unfair denials is complex and difficult.


In court lawyers have to produce evidence to support the argument that the injured worker was entitled to the benefits. To convince a judge that the insurer unfairly denied benefits, one must come prepared with supporting documentation, such as medical records and the testimony of eyewitnesses.


Injured workers are also much more likely to be successful if they file an appeal earlier rather than later. This is why it’s so important to obtain the assistance of a dedicated attorney who is well-versed in state law and can ensure that the appeal is filed correctly and on time.


Call a Member of Our Legal Team Today

At Krasno, Krasno & Onwudinjo, we dedicate ourselves to representing clients who have been unfairly treated by insurance adjusters who delay or deny workers’ compensation claims. To speak with a member of our experienced workers’ compensation legal team, please call us at (866)-948-9088 or send us a brief online message.

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