Many workers’ compensation claimants feel shocked and discouraged when they receive a letter stating that they are ineligible for benefits. In reality, a lot of claimants receive rejection notices after first applying. Reviewing some of the qualities shared by successful applications can help claimants prepare wisely and help businesses support their workforce.
Workers Get Emergency Treatment for Serious Injuries
If applicants report that they sustained a serious injury on-the-job, then it is important that they sought out medical care at an emergency department or urgent care center. If somebody waited weeks to get treatment for an injury, an examiner could conclude that the injury was not really as substantial as somebody reported.
Workers See the Appropriate Care Provider
Who a person may seek for immediate care may have some limitations. This depends on the terms of insurance coverage, employers’ internal policies, and state law.
There Is an Accident Report on File
State law governs what situations require a written report about an accident and who employers must relay reports to. In some jurisdictions and according to some OSHA regulations about accident reporting, companies must report accidents within a matter of days.
Medical Documentation Supports Specific Claims About an Injury
One of the main reasons why claims examiners deny applications is that they simply do not have adequate medical information corroborating what a claimant asserts about his or her injury. The information in medical records must correspond with the information in an employee’s account and any documented accident report.
Witnesses Have Consistent Accounts About What Happened
A lack of witnesses to an injury does not necessarily mean that an applicant should expect outright denial of a claim. However, it may be grounds for an examiner to call the authenticity of a claim into question. If there were witnesses to an accident, their reports must be consistent. If two witnesses say dramatically different things or their account differs from that of a claimant, an examiner may reasonably deduce that a claim is fraudulent. Witness’ statements should contain the same basic information about the circumstances that led to an accident and what happened immediately afterwards.
Claims Are Within Any Applicable Deadlines
Failing to file for benefits before a state program’s deadline will automatically result in denial. It is imperative that claimants be aware of any deadlines to file and submit every item of supporting documentation along with their application before their time runs out.
Being thorough about recordkeeping and paying close attention to administrative requirements can help to assure that claimants receive the workers’ compensation benefits that they need. Employers should try to be supportive of their personnel during the application process by getting them whatever information they need to strengthen their applications.
About InsureMyWorkComp
InsureMyWorkComp is a digital brokerage that helps clients find the right workers’ compensation solution for their business needs. Unlike other online platforms, we will help you to work with an agent who can provide you the right solution for your risk profile. Our staff has over 50 years of workers’ compensation underwriting and sales experience, and we are confident that we will provide you the support that you need. For more information or to get a quote, contact us today at (855) 340-9138.