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What Should I Do if My Workers’ Compensation Benefits are Delayed?

Many injured or sick workers may not receive Workers’ Compensation within a reasonable amount of time. There could be several reasons for the delay, and not receiving those payments can be particularly stressful, especially for an injured employee who is disabled.

In Delaware, companies who have one or more employees must carry Workers’ Compensation insurance, except for farm workers. When an employee has a workplace injury, they must request medical attention and notify the employer in writing immediately. If neither of these are done, the right for compensation could be put at risk. Employers need to file a First Report of Occupational Injury or Illness form with their insurance company and the Office of Workers’ Compensation within 10 days of the workplace accident, even if the injury is minor. States have other laws that govern how their Workers’ Compensation system is managed and administered.

If the employee qualifies, the Workers’ Compensation payments are generally paid out by the company’s insurance carrier and fall into three categories. The first is medical treatment and includes all of the necessary and reasonable medical expenses incurred for treating the work-related injury or illness. The insurance provider may choose to authorize certain providers to treat the condition, but if problems arise with this, the employee may be able to contest that. If benefits are delayed or denied, it is essential to contact a Workers’ Compensation lawyer for help.

Workers’ Compensation Payments

Employees with work-related injuries and illnesses can receive Workers’ Compensation benefits no matter who was at fault. In most cases, accepting these guaranteed benefits means that an employee cannot sue the employer for damages. Once the benefits begin, they are usually terminated when the employee goes back to work, but this is not always the case, especially if they continued working in a lesser capacity.

Temporary disability benefits come into play when an employee cannot work for a period of time due to the work-related injury or illness. In Delaware, these payments max out at 400 weeks, cover 70 percent of the employee’s gross weekly wage, and are tax free. Permanent partial disability can be paid out to injured employees who completed their medical care but have a significant loss of physical function. Other categories of benefits include temporary total disability, temporary partial disability, disfigurement, permanent impairment, and death.

What Causes Workers’ Compensation Payment Delays?

An employee should expect to get a notification about the decision in about two weeks. The employer, as well as the insurer, have legal obligations to respond to a claim in a reasonable timeframe. It is not uncommon for a Workers’ Compensation claim to be denied initially, but the employee may be able to file an appeal to have the denial overturned.

If the initial notification has not arrived or if there are delays after, there could be different causes. The problem could start at the beginning of the communication chain, such as if the employer did not notify their insurance company within 10 days after the accident. The employee may not have informed their company about the accident in a timely manner as well, or they may have hesitated to seek medical attention.

Insurance companies may choose to investigate a claim in more detail and will request for more time. If they have not received all the paperwork, obtaining that through the proper channels can add additional days and weeks. It can take time to gather paperwork. In some cases, there may have been inadequate training procedures, equipment and tool failures, or machine malfunctions, which will cause delays.

Also, the insurance carrier may take extra time if they are disputing a claim, and this happens more frequently when an employee has a preexisting injury. An employee with an occupational disease who files for Workers’ Compensation must prove their illness was caused from work.

What if Payment Delays Seem Unreasonable?

Unreasonable Workers’ Compensation delays are against the law. If it is proven that either party acts in ways that intentionally and unfairly hinder or prevent a claim, they may have to pay out more. If the Workers’ Compensation benefits are unreasonably denied or delayed, the injured employee might also be able to collect penalty benefits or interest.

Employees who are dissatisfied with their Workers’ Compensation may file a petition to the Office of Workers’ Compensation. Once this is completed, filed, and received, the Office of Workers’ Compensation may set up a pretrial hearing. On that day, a pretrial memorandum will be completed. The employee will describe all of the benefits they are seeking and can provide names of any witness that could be called to testify. A formal hearing date may be assigned, which would be conducted by a hearings officer. They can also file an application for an informal hearing or a claim petition; however, there is a three-year statute of limitations after the accident date. Legal representation is not required, but it is recommended.

Misconduct at Work

Determinations could also depend on state laws. Sometimes, there are extenuating factors that can affect the insurance company’s decision. One such case is if a colleague was angry at a co-worker and pushed them off a scaffold. Even though the co-worker sustained serious injuries, it was motivated by the co-worker’s personal reasons.

If an employee is acting out at work and is injured, such as participating in horseplay or consuming alcohol, it may lead to a delay or a denial. An insurer might also challenge a claim if they feel a pre-existing condition is to blame. They might think that an injury was caused outside of work. When the claim is unjustly delayed or denied, the best option is to contact an experienced Workers’ Compensation lawyer.

Wilmington Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Help Injured Employees with Delayed Benefit Claims

Workers who are injured or become ill during the regular scope of their employment should be entitled to Workers’ Compensation benefits, but delays can leave them in vulnerable positions. If your Workers’ Compensation benefits have been unreasonably delayed, reach out a Wilmington Workers’ Compensation lawyer at McCann Dillon Jaffe & Lamb, LLC. Complete our online form or call 302-888-1221 for a free consultation. Located in Wilmington, Delaware, we serve clients throughout the state, including Dover, Newark, and Middletown.