Overall Workers’ Comp Mistakes to Avoid

An injured employee is responsible for reporting an injury that occurred on the job and they will need to file for workers' compensation through their employer's insurance plan. This can be a complex process with many factors involved. However, employers will want to do everything they can to not leave an injured worker without the proper benefits they are owed. Here are the common mistakes associated with workers' compensation to avoid during a claim.

Failure to Report the Accident

Injuries must be reported in writing as soon as possible to make a workers' compensation claim. Employers must have reporting and responding policies established for worksite accidents. With no policy in place, the employee will have to come up with a report describing the injury and how it happened. The completed report must be given to the injured individual's supervisor or human resources department who will then work with the company's healthcare provider about how to move forward.

Failure to Submit Claims Promptly and Accurately

Claims begin by filing a form, which must be completed accurately and submitted within a specified period after the injury occurs to receive benefits. Incomplete or inaccurate forms could cause benefits to be delayed or even denied, regardless of a successful appeal. It may be beneficial to work with a legal professional to ensure benefits claims are complete and on time.

Inadequately Explanation of Injury

Healthcare providers working on the case must completely understand the injury, as the compensation is directly based on medical records and the accident report from the place of work. When a discrepancy occurs, medical providers act as the impartial bridge so their documents will be heavily used to make decisions. The doctors should know every detail of the accident and injury and how it has affected the lives of the injured.

Not Following Doctor’s Orders

Workers' compensation benefits exist to help injured workers recover. Those who seem to be impairing their own recovery could be denied or discontinued from benefits. Every doctors' appointment should be completed and the injured employee must follow the doctor's recommendations for medical treatment. If there is a disagreement with the doctor's orders that are illegal, steps can be taken to mitigate this. Otherwise, it is important to follow what the doctor of record on the claim recommends.

Not Getting a Second Opinion

Injured workers are required to see the doctors their employers direct them to in order to obtain worker's compensation. However, one's personal doctor should also be seen as they know the medical background. If the doctor that is partnered with the employment insurance gives a green light to return to work before full recovery, the personal doctor could feel otherwise. It is helpful if a personal doctor's opinion is on record as well to appeal for continued benefits.

Returning to Work too Soon

Before a return to work, it is advised to request a job description and have doctors review it as a way to check off the capability of performing those tasks during recovery time.  Injured individuals should never accept job duties the doctor does not approve of, therefore an appeal can be filed if the doctor disagrees with the insurance company’s doctor.

Not Seeking Work

On the flip side, those who have recovered and are fully capable of working should inquire about returning to work. Only the partially disabled must still seek to accept work that can be done. As recovery improves, the employee should check in with the employer about returning to work and update them with changes or accommodations that will be needed. Temporary assignments may be available in the meantime before taking on normal job duties. With reduced wages due to a lower-paying position, one can check if they are eligible for reduced-earnings benefits.

Agreeing to the Wrong Disability Rating

When the assigned doctor decides when the injury can be expected to recover there will be assigned a permanent partial disability rating to determine the final workers' compensation settlement. This rating should only be agreed upon after the individual has returned to work with the same level of pay before the injury. Consider the significant advantages of having NJ workers' comp insurance in place so you are not stuck in a time of need.

About David G. Sayles Insurance Services

At David G. Sayles Insurance Services, we help our clients decide which of these options is best for them based on their current situation and risk factors.  Contact us at 1-855-977-1842 or insureme@dsayles.mysites.io for a consultation!