Compensation insurance for workers is required by law for businesses in most US states. It is designed to ensure the protection of both the employee and the employer in the event of injuries occurring in the workplace.
If you experience an injury at work, workers’ comp assists in covering the associated costs of your injury, including medical bills, rehabilitation expenses, home care, and any equipment required.
Although most companies have insurance for precisely this reason, employers are often reluctant to award compensation benefits to their employees. An employee who has to deal with an injury, a complex filing process, and an employer prepared to fight your claim (perhaps with an army of lawyers) makes for a difficult set of circumstances – no matter your job role.
This is why preparing yourself with relevant information about workers’ compensation claims and working with the right compensation attorney is so important.
Here’s what you need to know about the workers’ compensation claim process, and what to do when your employer is uncooperative with your claim.
What is the “Workers’ Compensation Claim Process” and How Does It Work?
The workers’ compensation claim process is carried out by awarding compensation benefits to an employee following a workplace injury. This process includes everything from filing the claim, investigation by the claim adjuster, to administering benefits, including medical care and post-injury rehabilitation.
Following a workplace injury, the first step in the workers’ comp claim process is to report the injury or incident to your employer as soon as possible. It is important to do this promptly to avoid your claim being denied because the incident or injury diagnosis is reported too late. In most states, the incident or injury needs to be reported within thirty days from occurrence.
Reporting the incident to your employer starts the process. It’s followed by appointing a treating physician to your case and an investigation by a claim adjuster.
Employers are permitted to contest employee comp claims during this process for various reasons. This can include your employer saying that the injury or incident did not occur at the time or place of work, or you were doing a job not within the scope of your job description. Employers may also contest a worker’s compensation claim on the basis that the injury is not serious, does not require medical treatment, or they believe time off is not necessary for healing .
To avoid contestations, employees need to ensure that they have followed due process regarding incident reporting and injury diagnosis and keep a record of each stage of the claim process.
Why Do Employers Fight Worker’s Compensation Claims?
There are a multitude of reasons why employers fight comp claims. Companies fight compensation claims in their attempt to protect the business’s image, discourage other employees from filing compensation claims, and keep insurance premiums down.
Let’s break down each one below:
1). To Protect the Company’s Reputation
Employers have a vested interest in protecting the image of their business. Bad publicity of a business can lead to reduced profits and lower stock prices. Some companies fear that acknowledgment of harm caused and taking accountability by paying a compensation claim can lead to negative perceptions of the company. To stymie this, employers may attempt to fight a workers’ comp claim in a bid to avoid taking responsibility and having the incident linked to them.
2). To Discourage Other Employees from Filing
Companies fight workers’ compensation claims to illustrate to other employees that filing their claims is more effort than it’s worth.
Lengthy legal battles that result in a worker’s compensation claim being denied are even more of a deterrent to fellow employees seeking to file for compensation. They will be less likely to seek compensation for themselves if they experience a work injury.
3). To Keep Insurance Premiums Down
Workers’ compensation claims affect the insurance premiums of a business. Premiums are calculated using an algorithm made up of various factors, including the business’s experience modification rate (MOD).
A business’s MOD is based on how many OSHA filings that business has made. As the MOD value of a business increases, so do the workers’ compensation insurance premiums for that business, which is why companies want to avoid workers’ compensation claims.
What to Do When Your Employer is Uncooperative with Your Workers’ Compensation Claim
When facing an uncooperative employer, you need to be aware of the steps to make the filing process easier. Although you are entitled to file a claim on your own, the complex nature of the process can make this difficult.
At Emery Reddy, we believe employees have the right to compensation and quality healthcare in the face of workplace injury. Employees should not have to navigate difficult situations to be granted what they deserve.
If you find yourself facing the daunting task of filing a workers compensation claim, or needing to appeal following a denied claim, give us a call, and we will walk that road with you, doing everything in our power to help you along the way.