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While many companies invest money and time in safety programs or training to prevent workplace injuries, these on-the-job accidents still occur and can leave an employee unable to work for days, weeks, or even months. If you’ve been hurt at work, you will probably look to Worker’s Compensation to cover your medical bills and replace some of your lost income.
Worker’s Compensation is a no-fault system meant to be easily accessible for workers, yet some employees still have difficulty collecting their benefits.
Do You Need a Gwinnett County Workers’ Compensation Attorney?
A Gwinnett County Workers’ Compensation attorney can help you avoid common struggles with Workers’ Comp claims by reviewing your case and claim. If we believe additional documentation will be helpful, we can advise you on how to obtain it and what the insurance company will want to see.
If you have already submitted a Workers’ Comp claim and received a denial, we may also be able to help gather more evidence and appeal the decision. Please contact us immediately if your claim has been rejected so we can start working on your case.
The longer you wait, the more difficult it may be to find evidence to support your claim.
Who Qualifies for Worker’s Compensation?
Any employee who suffers an injury during assigned work hours should qualify for Worker’s Compensation in most situations. Sometimes, we see cases where there is a disagreement about whether an accident happened at work.
If you were performing a work task outside of the workplace when you were hurt, you should still be eligible.
Usually, injuries that happen on your lunch break or before you begin your work are not covered unless they are caused by an inherent hazard in the workplace. For instance, if you slip and fall on the breakroom floor because of a ceiling leak, you might be eligible for Workers’ Compensation.
If you have been told you are not eligible for any reason, it’s a good idea to check with an attorney. In some cases, a manager or HR clerk may be misinformed or misleading you to save the company money on insurance premiums.
What Are the Reasons for a Workers’ Compensation Claim Denial?
A no-fault system should make things easy for an injured worker who needs to recover benefits, but that’s not always the case. Almost all businesses with three or more employees are required to carry Workers’ Compensation insurance, so in most cases, your claim will eventually be reviewed by an insurance adjuster.
In general, insurance adjusters are concerned with reducing costs for the insurance company and are well-informed about what their policies do and don’t cover. They will comb through your claim, looking for any excuse to deny it, including some of these common reasons:
Denying You Were Injured
This is the first thing the insurance adjuster will consider—no injury, no payout. Frequently, insurance adjusters are inclined to think that workers are faking their injuries to collect benefits and avoid working. The reality is that Workers’ Compensation benefits only cover medical costs and two-thirds of an employee’s average pay, so this type of scam isn’t particularly lucrative. There may be a few people who will fake an injury so they can stay home at reduced pay, but this happens far less often than the average insurance adjuster believes.
The result is that your adjuster will open your claim and start looking for indications that you weren’t really hurt. Or, they may agree that you suffered an injury but believe it was mild and that you should be back at work already.
One thing adjusters look for is an injury that wasn’t reported right away or a situation where the worker didn’t seek medical help in a reasonable time frame after the accident. Although there are sometimes legitimate reasons for these issues, the insurance adjuster is unlikely to see your case that way.
The best solution to head off this type of denial is to:
- Report your injury to your supervisor immediately. We recommend keeping a record of your report in case your boss “forgets” to file your claim or says they don’t remember discussing your injury. You could send an email from a personal account or a text from your personal phone, so you can’t lose access to your messages. Include the date and approximate time of your injury and mention that you will seek treatment. This is also an excellent time to ask for a list of approved healthcare providers, which your boss is required to provide.
- Seek medical attention right away, even if you think your injuries are minor. Sometimes, an injury seems mild at first, and the employee believes it will heal on its own. Then, their pain worsens over the next few days, and they eventually see a doctor— but by this time, a week or more has passed.
Denying Your Injury Happened At Work
If you have extensive medical records clearly showing you suffered an injury, the insurance adjuster may accept that you were hurt. At this point, they will consider whether your injuries really happened at work.
This is sometimes an issue if no one witnessed your accident or if you have a repetitive motion injury, which occurs over time and is not related to any one specific incident.
If the insurance company denies your claim because they don’t think you were at work when you got hurt, please contact an attorney immediately. We’ll work to find evidence of how your injury happened, such as tracking down security camera footage, looking for witnesses, reviewing records of time card punches, and more.
If you have a repetitive strain injury, we may develop a strategy to show that nothing you do in your leisure time could have caused this type of injury. Or, we might interview medical experts about the work-related activities you do that could have caused it.
Claiming That You Were Intoxicated, Engaging in Horseplay, or Intentionally Injured Yourself
Even a “no-fault” system has exceptions; if you made a simple mistake—such as accidentally dropping a hammer on your foot—you can’t be turned down for being at fault. However, your claim can be denied if you were horsing around if you were under the influence at work, or if you hurt yourself on purpose.
These situations are often incredibly exasperating for an injured person who simply wants to access healthcare and lost income benefits. You may be inclined to call and argue with the insurance adjuster who thinks you were irresponsible or intentionally hurt yourself, but this is not a good option.
Many people make their cases more challenging by calling the insurance adjuster, who will record everything you say and look for more reasons to deny your claim. Instead, contact a lawyer right away and let us compile evidence to show that the insurance company’s claims are unfounded.
Claim? What Claim? What Paperwork?
Many Workers’ Comp claims are denied because certain paperwork wasn’t filed on time. Sometimes, the employer promises to put in a claim, then conveniently loses it, swears they submitted it, etc. Then, the worker tries to check on their claim and finds out it was never submitted.
This is why we advise keeping a written record of your reports to your employer in case you need to prove what you did and when. It’s also helpful to follow up with the HR department if you don’t hear back within 21 days, which is how long the insurance company has to conduct an investigation.
These investigations usually involve interviewing the injured employee, so if you don’t hear from the insurance company, you have reason to be concerned that your claim was never filed.
If your employer seems clueless or determined to ignore your rights as an employee, an attorney can help you file your own claim with the State Board of Workers’ Compensation. You should also know that you can speak with a lawyer confidentially during this time, either before or after filing your claim, for advice about the process.
We’re always happy to answer questions or advise clients before they speak with the insurance adjuster, which can be daunting for many people. It’s important to think through what you want to say and choose your words carefully because the insurance adjuster will be looking for any reason to deny your claim.
How Can You Get Assistance From a Gwinnett County Workers’ Compensation Law Firm?
Please contact the CEO Lawyer Personal Injury Law Firm for a free consultation. Our legal team will review your claim, advise you about any potential challenges, and answer any questions you have.
We can also check a claim denial if you’ve already received one, and in many cases, we have successfully appealed denials.
Attorney Ali Awad founded the CEO Lawyer Personal Injury Law Firm and worked tirelessly to transform it into one of the fastest-growing law firms in the country. Dedicated to helping injured people recover the compensation they need to move forward, he and his team have recovered millions of dollars for their clients.
When he’s not working on a case, Mr. Awad uses social media to deliver entertaining yet informative posts about legal topics to more than a million followers. Work with the CEO Lawyer today by calling 833-254-2923.