9 Reasons why your workers comp claim could be denied.

9 Reasons why your workers comp claim could be denied.

If your workers comp claim was denied, you should know you don’t have to take no for an answer.

The Workers’ Compensation system is complex, and your claim could be turned down for any number of reasons, but what you may not know is that if your claim is denied, you have the right to appeal this decision.

1. Your injury didn’t happen at work

To be eligible for workers’ comp benefits, your injury must have happened while you were performing your job duties.

For example, if you work in a restaurant and twist your knee while taking dishes to the kitchen, it’s likely you’re owed benefits. On the other hand, if you were injured while you were on your lunch break or on your commute to work, then you’re most likely not eligible to make a claim.

However, there is a grey area around this rule. If you were not at your jobsite but you were at a work assignment or event, such as a company retreat, you might have a claim.

You should keep in mind that insurance companies, and even your employer, might work very hard to try to prove that you were not at work when your injury happened, even if you know you were.

In a case where there are no witnesses or security camera footage, it can be difficult to challenge this decision. However, an experienced workers’ compensation attorney can be a powerful force in having this decision reversed.

2. You didn’t notify your employer of your injury within the required time

There are certain time limits in the workers’ compensation claim process. After you’re injured, it’s extremely important that you inform your employer about the injury as soon as you are able to. If you don’t report your injury as soon as possible, a number of things can happen.

Firstly, your employer will not be able to carry out an accident investigation, which is vital for the success of your claim.

Secondly, your employer, and the insurance company, can try to claim you were not really hurt at work, arguing that if you were hurt at work you would have reported the issue sooner.

Finally, the insurance company can try to claim your injury didn’t happen due to your job duties and argue that they were the result of a pre-existing condition or something that happened while you were off the clock.

3. You were intoxicated or under the influence of alcohol or drugs

Workers’ compensation is not about finding someone to blame. However, if alcohol or drugs were involved in your accident, you are not entitled to make a claim.

When you go to the doctor for a work injury, your boss has the right to require that you are tested for alcohol and/or drugs. If tests show that you were under the influence when the injury happened, then your claim will typically be denied.

4. You were not treated by an approved medical provider

Under the workers’ comp system, your boss and the insurance company have the right to provide you with an approved list of doctors you can visit to receive treatment.

In some instances, this may be a negative thing because these doctors can try to downplay your injuries, which means you could receive lower benefits.

Although you have to see an approved medical provider to be entitled to compensation, having the help of a workers’ comp lawyer will guarantee you the best chance of getting the treatment you require and the benefits you are entitled to.

5. You never received medical treatment

While you don’t have to see a doctor for every small scrape or bruise you get at work, if you think your injury is entitled to a claim, you will need the medical records to prove it. Without the supporting medical records, the insurance company can say you faked your injury to claim benefits, resulting in a denied claim.

Make sure you give your claim the best shot of being successful and visit a doctor.

6. You never filed your paperwork or failed to do so on time

There are specific time limits and deadlines for when you have to file your Workers’ Compensation claim. Even for injuries that develop slowly over time, like carpal tunnel syndrome, time limits apply.

If you do not file your papers on time, you are giving your employer and the insurance company another reason to deny your claim.

If you work with a Workers’ Compensation attorney they will be able to make sure you have all of your papers in order and that they are filed on time.

7. Your injury was the result of horseplay, roughhousing or practical jokes

If you’re goofing around at work and ended up getting hurt, it is unlikely that your injuries will be covered. In the eyes of the law, you are not considered working while you are roughhousing. So what can seem like fun and games can end up causing major stress later.

Similarly, if you start a fight at work and you get hurt, you generally will not be eligible for benefits.

8. Your injury is from a pre-existing condition

If you had an injury or illness before starting your job and your job did not make it worse, you are typically not eligible for workers’ compensation. The insurance company can and will fight very hard to get your claim rejected using this argument.

However, workers’ comp claims are complex and there is a lot of gray area. Some employees who are entitled to benefits see their claims rejected and do not fight back. Do not make this mistake.

9. Your employer disputes your claim

Your employer can, and most likely will, dispute your claim. They may be afraid that the cost of their workers’ comp coverage will increase if there is a claim on their policy. To combat this they could argue that the details of the case are incorrect or that you were not at work when you got injured.

This point can be especially true if there are no witnesses or surveillance footage to support your claim. If you were hurt and no one saw it, make sure you tell your employer and co-workers what happened as soon as possible.

10. You did not have a workers comp attorney

You do not have to have a workers’ compensation attorney to file a claim, but having one will definitely increase the chances of your claim being successful.

An attorney will be able to guide you through the process and advise you on the different steps and documents you need to give your claim the best chance of being successful.

If your claim has been denied, call Thomas Marchese. We can give you advice and we will improve the likelihood of your appeal being successful.

If you’re in pain now, wait until the paperwork starts.

If you’re in pain now, wait until the paperwork starts.

According to the National Safety Council, every 7 seconds, someone gets hurt while on the job. Not every injury will result in serious health problems or missed work, but any injury can cause health issues over time. If you’re one of the unlucky workers who have experienced more than one injury at a time, the process of filing multiple claims for workers’ comp can be daunting.

Do I need to file multiple claims for workers’ compensation?

Typically, if you sustain several injuries in one accident, all of those injuries are covered under a single claim. However, if you sustain injuries in multiple accidents, you may need to file multiple claims. The compensation depends on your unique circumstances, including the type of injury, the severity of the injury, and how the injuries affect your ability to work.

What if I have related injuries after the original accident?

All the physical symptoms of injuries may not surface immediately following the accident. In fact, some symptoms may not show for several weeks. For example, your doctor might diagnose a muscle strain in your back only to later realize you have a herniated disc; or, you might be diagnosed with a broken leg from a fall, then later realize your elbow was injured as well.

A workers’ comp attorney will guide you through the claims filing process, referencing relevant laws to ensure the maximum compensation to replace your income lost and cover your bills.

Situations that compound complexity:

Sustained multiple, separate injuries on the job
You are receiving compensation for an earlier injury and another injury occurs
You filed your original claim, then additional symptoms appeared

Attorney Tom Marchese practices workers comp law exclusively. For over 30 years Tom has guided his clients through the complex filing process, fighting claim denials, and achieving maximum compensation.

Every case is different, but one thing remains the same; if you’ve been injured on the job, you have rights.

Your consultation is free and without obligation. Call 614.486.3249.

Can I still get workers comp if I quit my job after getting hurt?

Can I still get workers comp if I quit my job after getting hurt?

Let’s take a look at a hypothetical situation. Let’s say you’re having a bad week. You’re carrying your piping hot coffee through the warehouse when you trip over some cables that were being improperly stored. You fall, hot coffee burns your hands, ruins your shirt and your morning and you landed pretty hard. In a huff, you pick yourself up off the ground, you mutter a few choice words and decide this is the last straw. You quit. A few days later, you’re still hurting. You go to the doctor who says you’ve got a herniated disc and second-degree burns. You’re going to need physical therapy and pain management, which means you’ll be out of work for a while.

You might be wondering, “Can I still get workers compensation if I quit my job?”.
The short answer is yes you can still qualify…but if you haven’t quit, don’t.

When you’re injured on the job and have a worker’s compensation claim, your claim really has two aspects, the medical portion, and the indemnity portion.

  • The medical portion is where the employer or their insurance is required to provide you the necessary medical care to provide either cure or relief, therefore, lessening the length of time that you’re unable to work.
  • The indemnity portion is where the employer or their insurance is required to pay you compensation for the time you’re unable to work.

While the two portions are interconnected in several ways, they are also largely separate and distinct. So, it’s certainly possible for an employee to quit their job and still receive workers’ compensation benefits, but the benefits might become limited if you quit your job.

Let’s revisit the example above:

Let’s say, the BWC or your employer agrees to pay for your therapy and will also pay you 2/3 of your wages while you’re out of work, but your employer tells you that if you want to continue to get health insurance while you’re out on workers comp, you need to pay for it at the COBRA rate, which is very expensive. So, you decide you’re not totally disabled, and that there are some things you can still do. You take a part-time job working for your friend. The job pays less than your old one, but it’s less physical, and it provides health insurance.

What happens to my open worker’s work comp claim if I get a new job?

Well, the fact that you left your job and took a new one should have no effect on your entitlement to medical care. Your new job isn’t aggravating your back, and it’s not preventing you from attending your physical therapy sessions. So, the worker’s comp adjuster should have no problem continuing to pay for medical care.

The other aspect of the claim, however, will be impacted. Now that you’re receiving wages, you certainly will see a reduction in the indemnity benefits you’re receiving. Those weekly checks that were $400 a week might drop to $150 a week now since you’re receiving wages from a new job. You may even see the checks stop completely if, for example, your old employer claims that they would have offered you a temporary, light-duty job at your pre-accident wage rate if you hadn’t quit.

Other things to consider.

Quitting your job could also hurt you when it comes time to settle your claim. The BWC prefers that a settlement agreement includes having the injured employee resign from their job. We take a strong stand for our clients in this regard and when clients don’t want to resign from their jobs, we try extremely hard to take that option off the table.

Another thing to consider is that the BWC or your employer tends to drag their feet on approving medical care, especially when they’re not paying someone weekly checks. When they know they are going to be paying a claimant until they recover, they have more motivation to give the medical care that will get you back to work.

Given all the factors that go into a worker’s compensation claim, it’s wise to consult with a worker’s comp attorney before taking steps that might impact your claim. Workers comp is all we do; give us a call.

I had a fall at work. Should I file for workers comp?

I had a fall at work. Should I file for workers comp?

When it comes to falls, the Bureau of Workers Compensation (BWC) has requirements that have to be met in order for the accident to qualify for coverage. Just being on the clock or at your employer’s location is not enough.

Trip and Fall Injury

Trip and fall injuries can happen no matter what type of occupation you have and are especially common. When you trip, the body typically falls forward. You tend to use your hands and knees to brace your fall. Therefore, a trip and fall tends to cause injuries in the hands, knees, face, or wrists. This is different from a slip and fall. (Read more about the differences here.)

Even if your accident and the resulting injury doesn’t seem serious, it’s still a good idea to get it examined by a doctor and to report the incident to your supervisor. Failure to do so may jeopardize ability to get Workers’ Compensation benefits for this injury in the future.

Trip and fall accidents may require medical attention and time away from work. If this has happened to you, consider filing for Workers’ Compensation to help pay for your medical treatment and related expenses.

Common Causes of Trip and Fall Injuries

Many types of soft tissue, bone, and nerve damage from trip and fall injuries can take weeks or even years to present themselves and you’ll need to have the medical evidence and paperwork to back you up in a Workers’ Compensation claim.

The most common causes include:

  • Tripping on wires or debris
  • Tripping on uneven concrete or pavement
  • Falling or tripping due to damaged work equipment or unkempt property
  • Falling from height (fall from scaffolding or other work equipment)

Trip and fall injuries in the workplace can have serious consequences. If you’ve experienced a trip and fall injury on the job and are having trouble paying for medical bills or making up for last wages, pursuing a Workers’ Compensation claim may help you stay financially afloat.

In a time that’s probably already confusing and stressful, it’s important that you follow these steps:

  • report the incident to your supervisor
  • see a doctor as soon as possible for treatment of injuries
  • write down your account of the event that led up to the accident and what occurred afterward
  • make a list of possible witnesses

Getting Your Workers Comp Claim Approved

You have to know the reason you fell. Simply reporting that you fell at work won’t be enough to get you workers’ compensation benefits. You also have to have suffered a fall that was somehow related to your job. If you fell because you were texting and walked off a curb…chances are that’s not going to be covered. If you fell because there was equipment being improperly stored and lose cables caused you to trip and fall, well, that’s a valid case.

If your fall at work was because an altercation with a co-worker turned physical, you likely will not be covered because workers compensation does not cover injuries stemming from personal disagreements. If you fell because you were drunk or high at work, you will not be eligible to receive workers’ compensation benefits because you were doing something that was not within the scope of your job. (Read more about drug use and workers comp claims here.)

If I was traveling for work and fell, can I get workers comp?

Let’s say you’re on your way back to the office after a business meeting but then make a small detour to stop by the grocery store and get injured in the process, you’re not eligible for workers’ compensation benefits. Once you veer off the path and embark on an errand that is not related to your job, workers’ compensation will not cover your injuries because this was no longer related to your job duties.

The difference between your claim being approved or denied often lies in the details. If you are still unsure if your injuries will be covered, call attorney Thomas Marchese. Workers Comp is all we do. The discussion is confidential and without obligation. Let’s get started.

LESSON LEARNED: If you are injured at work; don’t wait to file.

LESSON LEARNED: If you are injured at work; don’t wait to file.

Former Minnesota Vikings defensive lineman, Alapati “Al” Noga, 53, is not eligible for workers’ compensation benefits according to the state’s top court, following repeated head trauma that he claims caused a dementia diagnosis.

The Minnesota Supreme Court filed an opinion on July 24th reversing a Workers’ Comp Court of Appeals ruling that Noga was entitled to permanent and total disability benefits. Noga joined the Minnesota Vikings as a defensive lineman in 88 and played 73 games between then and 1992, then went on to play for the Washington Redskins and Indianapolis Colts.

The court found that Noga didn’t satisfy the statute of limitations to file a claim and, as a result, was denied. It further noted that at the time he played with the Vikings, scientists hadn’t yet discovered the connection between head injuries and long-term neurological disorders.

State law says that the timeframe to determine or recover benefits for injured employees is 3 years following the employer making a written report of the injury to the commissioner of the Department of Labor, but is not to exceed six years from the date the injury occurred.

Noga filed a workers’ compensation claim back in 2001 in Minnesota for his orthopedic injuries related to his time playing with the Vikings. He was reviewed by a doctor in 2003 who wrote months later that Noga’s orthopedic issues and neurological issues, which included blackouts and headaches, may be attributed to his injuries acquired while playing football.

Noga’s claim was eventually settled and he received benefits for the orthopedic issues. Because he knew about his neurological symptoms in 2004 and because the Vikings were made aware of them as well, the 6 year timeframe to file a claim started, a compensation judge determined, and both Noga and the Vikings agreed to that fact.

However, Noga had argued that because the Vikings and its Doctors treated his headaches with pain relievers at the time he was playing for the team, they waived the statute of limitations because they acknowledged then that he had a health issue stemming from the injuries. The Vikings argued against this assessment, and the court inevitably sided with the team.

The attorneys representing Noga said while they respected the court’s decision but were disappointed by it.

Noga testified that he’d tried to keep some of the head injuries to himself when he was playing because staff would respond to his concerns saying, “You’re always hurting.” He said he was later told by team doctors to play through the pain.

At the time, the NFL didn’t have a protocol in place for dealing with head injuries or possible concussions.

In the years since then, Noga has experienced several other conditions including gout, continued orthopedic issues, chronic pain, drug abuse, sleep apnea, depression, and neurological issues. He was even declared legally blind in 2009. In 2011, a doctor diagnosed Noga with dementia but said she couldn’t rule head injuries as the primary cause.

Noga’s lawyers later stated “The workers’ compensation system was adopted to provide compensation and care for injured workers, under today’s decision, many professional athletes in this situation will not receive that compensation and care. “

In Ohio, the amount of time injured workers have to file a workers comp claim is one year from the date of the injury or death. For workers’ comp claims involving occupational disease, you have 2 years to file a claim.

If you or someone you know has been injured at work, discuss it with workers comp Attorney Tom Marchese. The call is free.

File a claim.

Hurt at work? The importance of reporting every bruise.

Hurt at work? The importance of reporting every bruise.

When someone is injured on the job, all too often, the focus is on the most severe parts of the body hurt, while the minor aches and pains from other parts of the body are ignored. However, in a workers’ comp claim, it’s extremely important to report every ache, bruise, or swollen body part no matter how minor it may seem. Here’s why…

The human body is interconnected. When you fall, you might land on your knee, but your hands could have eased the impact, which can cause shoulder and arm pain down the line.

Or, if you injure your back, the nerve pain and/ or damage can cause problems in your legs. It might be a day or two before you feel any symptoms in those other areas, but these areas can get worse over time and require additional medical treatment.

It’s important in a workers’ compensation claim to document every part of the body that was affected by the accident no matter how small it might seem. It’s more difficult to try and convince an insurance company that another body part was also injured in the same accident if it wasn’t documented within a few days of the accident.

What’s In The Injury Report Matters

This rule is important to remember when filling out your workers’ compensation claim form, accident report at work, and any forms you’re given at the medical office you visit after the accident. All too often, I read emergency room reports where an injured body part is left out.

Hospitals are busy places and not everything is documented with 100% accuracy, but employers may use this to discredit your injuries. So, make sure to tell the medical professional you are dealing with every ache and pain you’re feeling.

 

Contact Us With Questions

If you have any questions about a new pain or problem that developed after your injury it’s always best to contact an attorney. We have years of experience and know the right questions to ask to ensure that you receive the full coverage, you are entitled to for your injuries. Call Tom Marchese today.