Employers and Workers’ Comp Claims.

Workers’ compensation, there is a pretty good chance you have heard of it. It’s a system where an employer purchases workers’ compensation insurance so that if their employees get hurt while on the job the employees are taken care of and the employer doesn’t have to pay their bills directly out of pocket.

So why then would an employer be against an employee filing workers’ comp?

One reason an employer might not want you to file a workers’ comp claim is if they are not carrying a workers’ compensation insurance policy. If this is the case then your benefits might be paid from a special fund by the state and then charged back to the employer. This also opens up the employer to be sued by the employee.

A more common reason is that employers are worried that their workers comp insurance premium will increase. Premium amounts can be directly affected when injured workers file for benefits. How that basically works is that insurance companies have people with calculators and spreadsheets estimating the possibility of someone getting hurt at a particular business. If or when that amount of people exceeds what they estimated premiums go up.

It’s not just the estimated amount of people the insurance companies figure out, it’s also the severity of the injuries. If someone has an injury but it happened to take longer to recover or they needed multiple surgeries and the injury becomes more expensive than the insurance company thought, they then raise the premium as well.

Employers and Insurance Companies

Because their money is at stake, employers and insurance companies hire investigators and independent medical examiners to keep tabs on the injured worker who filed workers’ comp. It’s unfortunate but some employers will refuse to believe the injuries were work related or if the injury was ever valid, which is called employer bias.

Can employers or insurance companies deny my claim?

It’s unfortunate if it happens, but yes, your employer and their insurance company may try and deny your claim. If your employer or its insurance company denies your claim, or any part of it, it should inform you in writing. Typical reasons given for denying a claim are:

• You didn't suffer a serious injury.
• Your injury didn't take place during work, or within the scope of employment.
• You don't need medical treatment for your injury.
• You don't need time off work for your injury.

It’s not over yet

If you received notice that your claim has been denied, it’s time to fight back by hiring a workers’ compensation lawyer and take your case to the NYS workers’ comp board. You will need to see this through as your health depends on it. You need to make sure your medical bills are paid and that you are getting workers’ comp benefits for hours lost.

This all starts with making sure you have everything documented since your injury. You will need the documentation telling your employer you were injured on the job. You will also need to keep records of your medical treatments starting from right after you were injured. Start with the hospital, emergency room or immediate care documents and continue on collecting documentation from your doctor or any other treating physicians or specialists you have seen. It’s also a good practice to keep track of the medications you are on due to the accident.

It’s important to not stop treatment until your physician says you are completely healed or as healed as you will ever get. If you stop treatment  this gives your employer and the insurance company reason to deny your claim It’s also important to go back to work when cleared, even if the company has to find you a different level of work. For example: if you hurt your back and can no longer lift things in the warehouse, your company might find you desk work which doesn’t affect your injury. In that particular case you must return to work.