What is what to do when workers' comp won't pay?

When your worker's compensation claim is denied or payments are stopped, here's a breakdown of what you can do:

• Understand the Denial: The first step is to understand why your claim was denied or payments were stopped. Obtain a written denial notice from the insurance company. This notice must explain the reason for the denial. Common reasons include:

  • The insurance company disputes that your injury is work-related.
  • The insurance company questions the severity of your injury.
  • The insurance company asserts that you did not properly report the injury.
  • Independent Medical Examination (IME) findings contradict your doctor's opinion.

• Appeal the Decision: You have the right to appeal the denial. The specific process varies by state, but generally involves the following:

  • Filing an Appeal: File a formal appeal with the appropriate state agency (often a workers' compensation board or commission) within the specified timeframe. Missing deadlines can result in the loss of your benefits. The appeal%20process is crucial.
  • Gathering Evidence: Collect additional evidence to support your claim, such as:
    • Additional medical records and opinions from your doctor.
    • Witness statements from colleagues or supervisors.
    • Photos or videos of the accident scene.
    • Your original incident report.
  • Mediation/Arbitration: Some states require or offer mediation or arbitration as a preliminary step in the appeal process. This involves a neutral third party who attempts to help you and the insurance company reach a settlement.
  • Hearing: If mediation/arbitration is unsuccessful or not required, your case will proceed to a hearing before an administrative law judge or similar official. You will present your evidence and testimony, and the insurance company will present its case.

• Seek Legal Counsel: Consulting with a workers%20comp%20attorney is highly recommended, especially if your claim is complex or denied. An attorney can:

  • Advise you on your legal rights and options.
  • Help you gather evidence and prepare your case.
  • Represent you at hearings and appeals.
  • Negotiate with the insurance company.

• Independent Medical Examination (IME): The insurance company may require you to undergo an independent%20medical%20examination (IME) with a doctor of their choosing. It's crucial to attend this examination, but also to:

  • Be honest and accurate when describing your symptoms and injury.
  • Bring a list of your medications and medical history.
  • Consider informing your attorney or doctor about the IME.

• State Workers' Compensation Agency: Contact your state%20workers'%20compensation%20agency for information about your rights and the appeals process. These agencies typically have websites with detailed information.

• Keep Detailed Records: Maintain meticulous records of all medical treatment, expenses, lost wages, and communication with the insurance company. This documentation is vital if you need to appeal the decision.

• Report Changes: Immediately report any changes in your medical condition, employment status, or contact information to the insurance company and the state agency.