An In-Depth Look at the Workers Comp Process

Ladyblogger
March 5, 2013

Workers’ compensation is a form of insurance that is mandatory in all U.S. states. If an employee is accidentally injured on the job or suffers an illness as a result of his or her work, they can collect a number of benefits, including compensation for medical bills and lost wages. State workers’ compensation programs are governed by an agency in each state that is responsible for implementing the program. Unfortunately, delays in processing are common. How to resolve the delay depends upon which party is causing the problem.

The Employer

After an accident, employers are required under various state statutes to provide employees with claim forms and provide their own documentation of the accident soon afterwards. Many employers will refuse to provide forms or delay in submitting their own forms. Either delay on the employer’s part can be easily remedied. Claimants should first familiarize themselves with which agency oversees the workers’ compensation program; this may be the Department of Labor, the Department of Human Affairs, or any other department.

If the employer refuses to provide forms, injured claimants can easily go online to the web site of the regulatory body in the state in which they reside and download the forms. If the employer refuses to submit his or her legally required documentation and the insurer is delaying the claim on that ground, first attempt to work the issue out with the employer. If the employer refuses or attempts to discourage the employee from filing a claim, contact the state’s regulatory body and file a complaint.

The Insurer

A common delay tactic used by certain insurers in the news, such as Travelers workers compensation insurance, is to continuously request additional documentation and claim that the application is incomplete. The state agencies regulating workers’ compensation will usually provide a linear and clear guide to the forms that an employee must submit in order to make a workers’ compensation claim. If the insurer appears to be acting in good faith and is requesting information that would help them assess the disability, submit the information in a timely manner to improve the claim’s processing time. This may entail submitting a large quantity of documentation, but the extent to which the claimant is disabled is very important and often disputed. Such decisions ordinarily require a large amount of information.

Insurers generally have a set statutory period in which to approve or deny the claim. If the claimant has not received notice by the end of that period, he or she should contact the insurer. A probable explanation for such a delay is that a request for additional documentation somehow did not get processed or properly sent to the claimant. If the insurer has all necessary information, yet the insurer is not reaching any decision as to whether to deny the claim, contact the insurer again and determine the nature of the problem. If no answer is forthcoming, contact the state regulatory agency and report the delay.

Workers’ compensation is intended to be a more efficient avenue for recovering damages than the conventional tort system. Litigation is both expensive and slow while employment-related injuries are common and involve damages that accrue rapidly after the injury. However, if the workers’ compensation system is not functioning properly, that efficiency is lost.

Freelance author Anthony Joseph writes about different areas of insurance laws, and contributes this article to promote the better understanding of workers comp laws. Sometimes Travelers workers compensation insurance claims have been shown to be unjustly delayed or denied. It’s known that some insurance companies can tend to be profit-focused, and will spend more time trying to prove that the claim should be denied. The attorneys at Doyle Raizner have the knowledge and tools to fight unjust claim denials and get you what you lawfully deserve.