Part Seven: Insurer Responsibilities In The Workers’ Compensation Claim Process
Pennsylvania employers are required to provide some sort of Workers’ Compensation health insurance for their employees in the event of a workplace-related injury or illness. The obligation of a workers’ comp carrier is to pay for treatment that is reasonable, necessary and related to workplace injuries.
While some employers choose to self-insure, most purchase policies from private Workers’ Compensation insurance providers.
After the initial claim has been filed by the injured employee, the insurer will step in and assume the employer’s responsibilities.
This means that the fate of many injured workers is left in the hands of outside companies who don’t always have a primary interest in providing fast and effective treatment for an injured employee. The worst case scenario is an insurance company that is far more focused on simply cutting their own losses.
Because these worst case scenarios exist, it is crucial for employees hurt on the job to seek the expert assistance of a Workers’ Compensation lawyer before they file a Workers’ Compensation claim.
A work injury lawyer has a thorough understanding of the responsibilities of the insurer throughout the claim filing process, is dedicated to protecting your rights, and can help you get the benefits you are entitled to by Pennsylvania state law. So if you were injured at work you should retain an experienced Workers’ Compensation attorney who can address your questions.
Insurance Company Duties
Once an injury has been reported to an employer, the insurer will essentially step into the employer’s shoes and take on its responsibilities, which can include:
- Confirming coverage
- Investigating the claim
- Making sure that medical care has been authorized and that health care providers have been given billing and reporting instructions
- Determining if compensation and medical care are payable
- Deciding whether benefits should be denied or delayed
Of these duties, conducting a thorough investigation is one of the most important, as the findings reached by the insurance adjuster will in large part dictate whether an injured worker can collect benefits.
Conducting A Post-Injury Investigation
Conducting a Workers’ Compensation investigation can be complicated. There are many details that need to be addressed by the investigation, such as:
- What type of injury was it?
- How severe was the injury?
- Was the employee working at the time of the accident?
Because there is so much at stake for both the insurer and the injured worker, most insurance adjusters take their time and conduct careful investigations.
Unfortunately, insurance companies dragging their feet has become an increasingly serious problem for injured workers waiting for their benefits. A worker has filed their paperwork on time, worked with their employer to do everything properly and needs those benefits to help with their recovery. And the worker’s timetable doesn’t fit in with the insurance company’s need to carefully investigate the claim, leaving workers frustrated.
In many cases, these delays can be attributed to poor procedural methods or inefficient investigative techniques. But that does little to alleviate the stress a worker feels being left waiting with no response from the insurance company.
Consulting with an experienced Workers’ Compensation lawyer can make all the difference in these situations. The lawyer knows that once an injury is reported the insurance company has an obligation to investigate the injury and either accept or deny the case within a set period of time. Meaning if the insurance company allows things to drag on too long, a lawyer can take action on behalf of their client and bad things can happen to the insurance company.
A work injury attorney is familiar with the legal duties and responsibilities of insurance companies and can ensure that a claim is processed as quickly as possible.
These investigative responsibilities include:
- Speaking with the worker’s employer about the injury
- Interviewing the injured employee about how the injury occurred
- Contacting the injured party’s physician to verify the scope and nature of the injury, as well as any limitations caused by the injury
- Interviewing any witnesses who saw the accident occur
During these interviews, the insurer will usually ask a variety of in-depth questions, including:
- Where the injury occurred
- Whether the employee was fulfilling his or her regular job duties at the time of the accident
- Whether a third party was responsible for the accident
- Whether anyone witnessed the accident
- The identity of any eyewitnesses
- Whether the doctor provided a diagnosis, prognosis, work restrictions, or treatment plan
- Whether the injured employee was treated by a designated health care provider
- Whether the employee suffers from any prior injuries
- What kinds of work the employee is still capable of completing
The injured worker, his or her employer, and any witnesses will also often be asked to describe the injuries sustained by the employee, including symptoms and pain levels. They may also be asked to repeat the details of the accident on a number of occasions, which can become more difficult over time as memories become hazy.
Fortunately, a Workers’ Compensation attorney can prepare injured workers for these interviews and ensure that they are not taken advantage of by the adjuster.
The work injury lawyer is on the employee’s side and will make sure that their client is protected. Their guidance and counsel will keep the interview focused. Their clients will not give any information to the insurance company without being thoroughly vetted together.
The Workers’ Compensation lawyer will keep the insurance company from putting words into the mouth of their client, giving an insurance company any reason to deny the case.
Most insurers also require injured employees to contact them after each doctor’s visit and provide an update on any new work restrictions or treatment plans.
Contact A Dedicated Workers’ Compensation Attorney
At Krasno Krasno & Onwudinjo, we know dealing with your employer’s insurer after an accident can be intimidating. In some cases, employees are still suffering from painful injuries, and the stress that comes with Workers’ Compensation cases can make it difficult, if not impossible, to focus on recovery.
Working with an attorney who can help shoulder these burdens can make all the difference in whether or not a claim is successful, so if you were hurt at work, please contact us at (866)- 948-9088 to speak with an experienced Workers’ Compensation lawyer about your own case.