Are you injured at work and not sure how to maximize your claim?
Workers’ compensation is complicated. The forms and time limits, the insurance company’s delays and tricks. It’s a lot to deal with when you’re hurt and trying to get back on your feet. So here’s the straight truth:
Most workers miss out on thousands of dollars.
Sound unbelievable? It’s because there are a few simple strategies that every worker needs to know. In this article you’ll learn the exact steps to take in order to maximize the value of your workers’ comp claim. Let’s get started.
Here’s What You’ll Learn:
- Why Workers’ Compensation Claims Are Denied
- Documenting Your Injury Correctly
- When You Need Legal Assistance (And When You Don’t)
- Maximizing Your Settlement Value
Why Workers’ Compensation Claims Get Denied
Did you know that a large percentage of workers’ comp claims get denied in the US?
An average of 20% of claims are denied. That’s one out of every five injured workers who don’t get the benefits they deserve.
This is important to understand:
Insurance companies don’t care about you. Their goal is to deny your claim or pay as little as possible. Here’s how they try to do it:
- Missing deadlines for reporting your injury
- Inadequate medical documentation
- Denial based on whether the injury is “work-related”
- Arguments that you were hurt by a pre-existing condition
But here’s the interesting thing…
If you have a complicated injury or are denied, the best thing you can do is to work with a workers comp lawyer in Fresno. Your attorney will know how to get your claim approved and maximize the benefits you are entitled to.
Document Everything From The First Day
This is simple advice but where most people fall short:
Start documenting the moment you get hurt.
And I mean all the details:
- Time, date and location of the injury
- Activity you were doing when the injury occurred
- Names of any witnesses
- Photos of the scene/injury
- Doctor visits, treatments, progress reports
It’s like building a case against the insurance company. That’s because that’s exactly what you’re doing. They’ll find any reason to deny your claim if you’re not meticulous with your documentation.
Insurance adjusters love to pick apart claims with holes in them. Don’t give them that opportunity. Keep a daily journal of pain levels, how your injury impacts daily tasks and all conversations with medical providers and the insurance company.
And something critical here…
Report your injury right away. Most states require that you notify your employer within 30 days or less. The longer you wait, the more suspicious they become. Missing a few days here and there is a red flag to the insurance company.
Medical Treatment: Do’s and Don’ts
Ok, let’s get into the nitty gritty of medical treatment.
Believe it or not, it matters which doctor you see. In some states, your employer/their insurance company can force you to see a specific doctor. The problem is these doctors may minimize your injuries or give less-than-accurate testimony later.
But here’s a couple tricks…
Get a second opinion from your own doctor when possible. Make sure each medical visit is documented and that each doctor is fully aware of your injury is work-related.
Never downplay your pain or symptoms either.
If you try to “tough it out” and tell a doctor you’re feeling better, it goes in your medical records. Then when you need more medical treatment later on, the insurance company will use your own words against you.
Be clear and consistent about:
- Pain levels (use a consistent 1-10 scale)
- How your injury limits daily activities
- Any new symptoms that develop
- What medications you’re on and how effective they are
The medical record will be the foundation of your workers’ comp claim. Make sure it is complete and accurately portrays your injury.
When To Get A Lawyer
Not every workers’ compensation claim requires a lawyer.
In many cases where the claim is simple, the employer has accepted the claim, and the employee is able to return to work relatively quickly, the worker may be fine going it alone.
However, there are cases where legal representation is absolutely necessary. These include:
- Claim denial or dispute
- Permanent disability
- Inability to return to work
- Insurance company making a settlement offer
- Employer retaliation
Facts are…
Workers who hired lawyers received 47% more in benefits. That’s a massive difference when talking about thousands of dollars.
Lawyers know how the system works. They know the tricks insurance companies use and how to fight back against them.
Maximizing Your Settlement Value
Ok, now let’s talk about how to get the full amount you deserve.
Most workers’ compensation cases end in a settlement. This is where the insurance company offers a lump sum amount to resolve the claim and close it out. Seems pretty straightforward right?
Here’s the problem:
The insurance company’s first offer will always be low. They know you will negotiate and if you accept their first offer, they have you over a barrel.
Before you even think about a settlement, consider the following:
- Future medical treatment you may require
- Permanent disability and its impact on future earning capacity
- Vocational rehabilitation if you can’t return to your old job
- Whether a lump sum or structured payments make sense
This is where a lawyer can be beneficial in helping you determine how much your claim is actually worth based on other similar cases and your specific situation.
Understanding Your Workers’ Comp Benefits Package
Workers’ compensation benefits are more than just medical bills.
In fact, there are several different types of benefits you may be entitled to receive, which include:
- Medical benefits for treatment of your work injury
- Temporary disability benefits if you can’t work
- Permanent disability benefits for lasting impairments
- Vocational rehabilitation if you can’t return to your previous job
- Death benefits in the event of a fatal workplace injury
Many workers are not aware that they may qualify for more than one type of benefit. Don’t assume, ask questions, and make sure you are receiving all the benefits to which you are entitled.
The Appeals Process: Fighting Back Against A Denial
Denied? Don’t give up.
The appeals process is in place for a reason. Insurance companies count on injured workers throwing in the towel after an initial denial. Don’t be that statistic.
The appeals process can vary by state but typically involves the following steps:
- Filing a written appeal with the state workers’ comp board
- Gathering additional evidence and documentation to support your claim
- Attending a hearing before an administrative judge
- Presenting your case with any witness testimony
The important thing to know is that most states have deadlines for filing an appeal (typically 30-90 days). If you miss that deadline, you lose your right to appeal.
Getting a lawyer for the appeals process is another situation where a lawyer can be helpful. They know the process, the deadlines, and how to present your case in the best light.
Wrapping Up
There’s nothing complicated about maximizing your workers’ compensation benefits. It just takes a little knowledge and strategy.
The key strategies:
- Document everything from day one
- Report injuries immediately
- Be honest with your medical providers
- Don’t accept the first settlement offer
- Get legal help when your claim is denied or involves permanent disability
- Know all the types of benefits you are entitled to
- Fight back if your claim is initially denied
Workers’ comp is there to protect you if you get injured at work. Insurance companies are there to cheat you out of as much as they can. Don’t let them. Use the strategies in this article and you will maximize the benefits you deserve.
Remember that your injury is serious. Your claim should be serious too.
