Workers’ comp claims don’t end at denial
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Workers’ comp claims don’t end at denial

| Sep 10, 2020 | Firm News

When an injury happens at work, there are certain protocols the injured worker should follow to increase their chances of an approved claim. These steps include documenting the injury site to expose the hazards and employer negligence that ked to your injury.

In addition to gathering evidence and an eyewitness, you should report the injury and see a physician as soon as possible. Any reporting delays can hinder your credibility. Also, track any expenses that occur due to the injury like medical bills, miles traveled to and from the doctor’s office, rehab facility, or to pick up a prescription. Also, keep track of any bills you have been unable to pay because your injury left you unable to work.

What if you think you did everything right and even acquired legal representation to defend your side, and still, your claim was denied?

Don’t lose hope.

Do conversions equal dollars?

Lockton, a privately held insurance brokerage firm, released a study revealing that 67% of all workers who had their initial claim denied had their claim converted within 12 months. On average, the converted claims paid the claimants 55% more. Lockton’s study pointed out that the average compensation for an initially approved claim hovered around $10,153, whereas a rejected and converted claim paid claimants, on average, $15,694.

Common reasons for claim denials include:

  • No medical evidence that injury occurred (See a doctor)
  • The injury does not meet the employer’s statutory definition
  • Reservation of rights
  • A pre-existing condition led to injury
  • Idiopathic medical condition (unknown cause) led to injury
  • Intoxication led to injury
  • Non-work related stress led to injury
  • Untimely reporting of injury
  • Your role doesn’t meet the statutory definition of a company employee
  • Worker misrepresented the events leading up to the injury (Keep your stories straight)

While those figures equate to a silver lining, the numbers indicate that 33% of rejected claims were not converted. That’s why it’s essential to do everything right after suffering a workplace accident as one procedural slip-up can cost you.