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Everything Injured Workers Need To Know About Workers’ Comp

A man with a broken leg on the phone

Getting injured on the job can be a stressful situation no matter how serious the injury may be. Most injured workers are unsure of what to expect after sustaining an injury and how to go about getting started with a workers’ compensation claim. Should the unfortunate event of a work accident happen, it’s extremely important to understand how the process works so you can increase your chances of a favorable decision. Here are some facts to know, as well as the steps to take following your work injury.

The Work Accident Report

After sustaining an on-the-job injury the first, and one of the most important things you can do is report the accident to your employer. Without reporting your accident, it will be virtually impossible to file a claim. Your accident report should include the following details:

  • Time and date of the work accident
  • Names of anyone who witnessed the accident
  • Location of the accident
  • Where on your body the injuries were sustained

Having an accident report handy can also help aid in remembering the details of your accident should you be called upon for an interview.

Common Reasons for a Claim Denial

While workers’ compensation claim denials are not uncommon, you do have the right to appeal the decision. When appealing a decision, first and foremost, it’s important to know why your claim was denied so you don’t make the same mistake again. Here are some common reasons injured workers may not receive a favorable decision:

  • Missed filing deadlines.
  • Missing information on filed paperwork.
  • The employer is disputing the claim.
  • The employer was not promptly notified of the work injury
  • The injured worker failed to get medical treatment.
  • Lack of evidence to support the injury occurred in the workplace.
  • The claim was filed after the injured worker was fired or laid off.
  • There were no witnesses to the injury.
  • Discrepancies were found when comparing report to medical records.
  • The injury occurred while claimant was under the influence of drugs or alcohol.
  • The illness or injury is not covered under workers’ compensation or believed to be serious enough for coverage.

If an injury was not reported to your employer within 30 days, you could lose your right to file a workers’ compensation claim.

Why Choosing the Right Doctor is Critical

While you may feel comfortable with your primary care physician to assist you in your workers’ compensation claim, he or she may not be experienced with all claim procedures. Also, you may be required to only go to a doctor listed under your employer's workers’ compensation plan. If the doctor you choose isn’t listed, and he treats your injury, most likely it will not be covered.

Choosing a doctor with little to no workers’ compensation experience can be detrimental to your case. Your doctor should be able to meet reporting deadlines and know how to properly fill out forms. Any missed deadlines or missing information could cost you a favorable decision.

How to Communicate With Insurance Companies

Typically you will receive a call from the insurance company within 48 hours after filing your claim. While you should take the call, keep in mind that the representative is going to make small talk and be friendly to make you feel comfortable so they can obtain as much information from you as possible. It’s best to stick only to the facts. Insurance companies are highly trained in finding even the smallest reason to deny your claim.

What To Do If You Are Fired for Filing a Work Comp Claim

If you suspect you have been wrongfully terminated for exercising your right to file a workers’ compensation claim after sustaining an injury, contact a workers’ compensation attorney as soon as possible. The State and Federal government protect employees from practices that threaten job security based on unlawful or unethical practices.

If you’ve sustained a work injury, having an experienced injury attorney on your side can make all the difference in the outcome of your workers’ compensation claim. Let us navigate the often confusing world of workers’ compensation claims and get you the money and peace of mind you deserve. The Law Office of George P. Escobedo & Associates, PLLC understands the frustrations that come with filing a workers’ compensation claim. Don’t go up against the insurance companies on your own. Call us at (210) 807-3178 to discuss how we can help with your case.

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