Workers' Compensation Claim forms & denied claims
IF YOU RECEIVE PAPERWORK REGARDING A REQUEST FOR A QUALIFIED MEDICAL EVALUATION (QME) CONTACT OUR OFFICE IMMEDIATELY.
I Just Filed a Claim, What Is This Insurance Paperwork?
If you are injured on the job, it is of the utmost importance to report the injury to your employer. Prompt reporting and transparency can mean the difference between the acceptance or denial of your claim. If the injury is serious or life-threatening, seek medical attention immediately. Be sure to inform the medical staff that your injury is job-related.
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.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.
Filling Out a Workers' Compensation Claim Form
After you have been treated for your injury, you may choose to fill out a claim form. Your employer is required to give you a Workers’ Compensation claim form (DWC 1) within one working day after you report your injury or illness. Read the instructions carefully on the form and fill out the “employee” section. You will need to describe your injury in detail.
After you have made a copy of the DWC 1 form for your records, return the original form to your employer. This is called “filing the claim.” If you do so by mail, be sure to use first-class or certified mail, and request a return receipt. Within one working day, your employer must give or mail you a copy of the completed form with the “employer” section filled in. Keep this for your records.
Contact Gerald Brody & Associates for Help with Workers' Compensation Paperwork
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 at (619) 528-9800 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.
What Do I Do if My Workers' Compensation Claim is Denied?
You get injured in a workplace accident and want to file for workers’ compensation to cover your medical costs. You fill out a form to file a claim for workers’ compensation and are pretty confident you did everything correctly. However, soon after filing the claim you get a notice back that your workers’ compensation claim was denied. Now that the claim was denied, what do you do next? To get expert advice on what to do next, give us a call at (619) 528-9800.
Why Was My Workers’ Compensation Claim Denied?
Before we figure out the next steps, it is important to try to understand why your claim was denied. Below you can find some of the most common reasons for a workers’ compensation claim getting denied.
You Were Late Filing Your Claim
There is a timeframe you must follow when filing a workers’ compensation claim, and if you are late the claim can be denied. In California, you must notify your employer that an accident occurred within 5 days of the injury occurred, and paperwork must be submitted within 30 days. Any tardiness can be a sign that the injury or accident was fabricated, and the claim will be denied.
Your Employer Disputes the Claim
Your employer has a vested interest in your claim not being approved, so they may deny the claim if there is not sufficient evidence. That is why it is important to have witnesses, a doctor’s statement, and other evidence.
You Were Intoxicated
If you were under the influence of drugs or alcohol when the accident occurs, the claim will likely be denied. Your employer can request a drug and alcohol test when you visit a doctor for your injury.
You Have an Old Injury or Pre-Existing Medical Condition
If the accident aggravates an old injury, you will need to provide enough evidence that new trauma caused the injury, and it isn’t a flare up of your old medical condition.
You Didn’t See a Doctor
Your claim can be denied if you did not seek medical treatment for your injury and have a medical record. Seek treatment as soon as possible after your injury.
What If My Employer Refuses or Delays My Claim, or Fails to Give Me Paperwork?
It is the obligation of your employer to give you the materials you need to file a workers’ compensation claim. If your employer is delaying your claim, refuses the claim, or fails to give you the paperwork you need to submit a workers’ compensation claim, you need to talk to an attorney as soon as possible. A good workers’ compensation attorney can help you make sense of the complicated procedure and make sure your employer is treating you in a fair and just manner.
What Do I Do If My Workers' Compensation Claim is Denied?
Although you follow proper protocol for filing a workers' compensation claim, your claim still may be denied. If your claim has been denied, you need to contact a workers’ compensation lawyer as soon as possible to file an appeal. The professional attorneys at the Law Office of Gerald D. Brody & Associates in San Diego are here to assist you and help you make sense of the complicated workers' compensation system. If your claim is denied, we will fight for your rights and get your workers’ compensation claim approved. Give us a call at (619) 528-9800.