I Just Filed a Claim, What Is All of This Paperwork the Insurance Carrier Sent Me?

You’ve filed a workers’ compensation claim with your employer and now you’re receiving letters and documents that require your review and signature from an insurance company or third party administrator.

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Workers’ Compensation is a specialized system that involves the understanding of medical-legal terms, so in many cases employers or their insurance companies have retained a third party to administer the benefits associated with a work injury.

Just because your employer is aware of the injury doesn’t mean that information has been adequately forwarded to the insurance carrier or administrator. In order for the carrier or administrator to complete their review of your claim, they will likely require you to provide a medical release. Think of it this way: if you have allegedly suffered a slip and fall and sustained an injury to your lower back, you have made a claim for an orthopedic injury. Thus, the carrier/administrator needs to review your orthopedic medical history to make sure they are providing appropriate benefits. In a system where historically there has been a lot of insurance fraud, carriers scrutinize each claim.

You may also have to give a statement. A lot of times an employer will require you to provide an incident report. If this is not provided to the insurance carrier, they will require the facts surrounding your claim of injury. Statements can be recorded by an investigator and may be dissected by the insurance carrier to find a way to deny you benefits. If an insurance carrier wants to take your statement, it is a good idea to discuss the facts surrounding your injury with an attorney so that you know what you should and should not say to the investigator.

In conclusion, it’s normal for you to receive a lot of paperwork to fill out when you file a claim. When you receive paperwork you don’t understand, we are here to help. Please give our office a call and in most cases we can provide the assistance you need regarding claims paperwork over the phone. If necessary, we are more than happy to sit down and have a face-to-face consultation regarding your claim.

IF YOU RECEIVE PAPERWORK REGARDING A REQUEST FOR A QUALIFIED MEDICAL EVALUATION (QME) CONTACT OUR OFFICE IMMEDIATELY.