After a legitimate injury at work, you may be seeing firsthand what a difficult, complex workers' comp system you are now in. And if you're not seeing it yet, you will. Unfortunately, there are several things they can do to deny or delay payments and medical treatment, and there could be many reasons the insurance company isn't paying you.
But don't worry - there are ways for us to combat this.
Workers Comp Excuses
for Denying Legitimate Injuries
1. The insurance company says they need a medical release to get your medical records.
The medical authorization release forms insurance companies use will usually allow them to get all of your private medical information (counseling, addiction treatment, ob-gyn, etc.) since your birth. Literally, every peice of medical information (plus talking to any doctor you've seen about your heath) in your life. What does this have to do with the broken arm you suffered after a fall at work?
I never let my clients sign these - in fact I tear them up in my office. You can go to the doctor or hospital and get a copy of your records to send to the insurance company. A signed medical authorization just gives them cover to investigate the concussion you had when you were 12 and fell off your bike, or that fender bender in 2005 when you hurt your foot.
None of that has anything to do with your broken arm.
2. The insurance company says they need your recorded statement.
The insurance adjuster has already talked to your boss, superintendent and co-workers about how the injury occurred and you probably told your boss or filled out an incident form after the injury. If they think you faked the injury or that the injury didn't happen at work, they have enough info already to make that decision. All they are looking for in a recorded interview (and your adjuster has done hundreds if not thousands of these) is ways to deny or delay your legitimate workers comp claim - to pay you less or authorize less medical treatment that you need.
They will ask you about things that have nothing to do with how you got hurt, your medical treatment or diagnosis. And what if you leave something out or don't remember a critical detail? What if you misstate something your doctor told you? How will that look?
What if you're on medication or in significant pain from the injury? Are you going to remember everything?
I never let my clients give these statements. And if they give one before they hire me to represent them, we spend a lot of time and effort to make sure it is supplemented so it's accurate and right and doesn't give the insurance company any reason to deny or delay a legitimate claim.
3. We're waiting for authorization from the employer.
Unless your employer says you made up the injury (remember, we're talking about legitimate work injuries here), this is total BS. It takes about 5 minutes to verify workers' comp insurance coverage and that someone was on the job when they got hurt. More often than not, if this goes past a day or two, the workers' comp insurance is stalling - trying to come up with a way to deny or delay your benefits.
Unfortunately, D.C. workers comp law doesn't have an immediate remedy for denying or delaying benefits without a reason - you will need an experienced workers' comp lawyer to file for a hearing to force the workers' comp insurance company to do the right thing.
Want to find out more about how to choose the best D.C. workers' compensation lawyer for your case? Call today for a copy of our free Workers Compensation Lawyer Evaluation Form. And get the only book on D.C. workers compensation written just for workers who get hurt on the job by a practicing lawyer certified by the National Board of Trial Advocacy (you'll find out why that's important and much more about the process of your workers' comp case).