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What Should I Do If I was Denied Workers’ Compensation Coverage?

Injured workers often assume that Workers’ Compensation insurance will cover them when become hurt on the job. Although this may be true most of the time, there are instances in which employees are denied the benefits for which they are entitled. A denied Workers’ Compensation claim might inspire anger, stress, and questioning in the victim.

It helps to reach out to a Philadelphia Workers’ Compensation lawyer to ensure that the case is managed properly. Workers need to focus on their recovery, but they often do not understand the legal process. Concerning the reporting process for work injuries, there are a few scenarios that help workers understand what to do when they are hurt. Although the injured employee will seek treatment for their injuries, they also need to know how to approach Workers’ Compensation claims.

What Should Workers’ Compensation Coverage Do for the Victim?

Workers’ Compensation coverage is required by state law for all employees except executives, housekeepers, and independent contractors. Traditional employees with businesses throughout the state are supposed to be covered when they are injured at work. The Workers’ Compensation insurance provider often handles claims unless the business has a self-paid insurance plan. The business must explain to employees that they are entitled to Workers’ Compensation coverage, and the company should also create a reporting procedure for everyone in the facility.

Managers need to be prepared to accept reports from employees, and each manager must understand how to send those reports to the insurance provider or insurance department. If the business is not operating in this manner, claims may not be filed properly. Although the business cannot be sued for any injuries that have occurred, a Workers’ Compensation lawyer might press the company to send a claim and request coverage for the victim.

The insurance company will receive the claim and likely pay for all medical expenses, along with lost wages. The insurance company even gives the employer a list of covered doctors with whom the carrier works. The employees need to know where they can go for treatment, and they should not be asked to do much beyond reporting their injury and receiving treatment. Unfortunately, this is not always how Workers’ Compensation claims are managed. Employees who are denied or not allowed to file a claim will need assistance from an attorney because they were not provided the benefits of the traditional Workers’ Compensation process.

What If I was At-Fault for the Accident?

Workers’ Compensation is a no-fault system. Workers who are injured can be compensated even if they caused the accident. The only exceptions to this rule are employees who were not performing their job duties properly or violating the law. When a business or insurance carrier blames the employee for the accident, they are working outside the bounds of traditional Workers’ Compensation law. The company might claim that the employee was breaking the law or not performing their job properly. In these cases, a Workers’ Compensation lawyer must show that the worker is entitled to coverage.

Injured workers should not say anything about the accident other than providing basic information. They do not want their words to be twisted and give the insurance company reason to deny the claim. If the details of the accident are a bit unclear, it helps to work with a lawyer who can ascertain the truth.

Suppose a Faulty Tool Caused the Accident?

Although Workers’ Compensation insurance covers everyone regardless of the circumstances of the accident, other factors may also be blamed for the accident, such a defective tool or piece of equipment. In these cases, the worker can file a third-party claim against the manufacturer of the tools or machines that malfunctioned. The employee can still receive Workers’ Compensation insurance coverage, but they can also file a claim against the manufacturer. Workers’ Compensation cannot be canceled by a third-party claim.

What If I Slipped and Fell?

Slip and fall accidents are common, and they can occur on a work site or in an office. Workers who slip and fall are not liable for their own injuries. Some workers might fall from heights because the scaffolding or structure they were walking on was unstable. Workers might slip on wet floors, or they might fall when tripping over machinery, tools, or parts.

Slip and fall accidents are not always serious. The worker might fall backwards, catch themselves, and get back up. Unfortunately, they might have sustained a range of injuries because of this minor fall. These accidents warrant a visit to the hospital or doctor, but the employer or manager might not allow the employee to report the accident. Injured employees should reach out to a Workers’ Compensation lawyer for help with these cases.

The insurance company might claim that the injuries do not rise to the level of an insurance claim. The carrier might also claim that the employee was not hurt on the job. Therefore, a lawyer should collect evidence that shows the employee was hurt at work, even if their accident was relatively minor. In these cases, even minor events are considered injuries so long as they occurred on the job.

What If I was Injured While Working Alone?

Nighttime and third shift workers often work alone. Anyone who is working alone should ask for a personal alarm or keep their cell phone with them at all times. Most facilities have security cameras to protect the property. Injured workers can call their managers or the business owner, obtain coverage, and seek medical attention. Even though the worker was alone, security camera footage can show where the accident occurred.

If there seems to be no proof that the accident occurred, victims should ask a Workers’ Compensation lawyer to help prove that they were hurt while performing their duties appropriately. If possible, employees should remain in an area that is surveilled throughout their shift.

How Long Do I Have to Report an Injury?

Workers in Pennsylvania have 21 days from the date of the incident to report an injury to their employer. At the same time, they have three years to file suit against the insurance company if the claim was not paid. Workers should report their injuries as soon as possible so that they can avoid any delays. Moreover, the employee should record the date and time that they reported the injury. If there is any confusion or the claim is denied, the employee can show that they followed the rules set forth by the state. When employees believe they cannot report their injuries, they must reach out to a Workers’ Compensation lawyer for assistance. A lawyer must be aware of the case before the three-year statute of limitations expires.

What Evidence Should I Collect at the Scene of an Accident?

Injured workers should do their best to collect evidence at the accident scene because this information helps their lawyer with a claim. Employees who are hurt on the job need witnesses who can attest to the manner in which the accident occurred. Someone who is badly injured should be sent to the hospital while other people on the scene take pictures or videos of the area. This information can also be forwarded to a Workers’ Compensation lawyer for review. Co-workers who are not injured must be prepared to help their friends and colleagues by taking pictures and collecting evidence. These same people can speak to the lawyer, explain what happened, and even help their co-worker report the accident.

Should I Seek Immediate Medical Attention?

Those injured on the job must seek medical attention as soon as possible. If the accident or injury is severe, someone on the scene should call 911. An ambulance can take the employee to the hospital, where they will be treated as quickly as possible. The hospital opens a chart for the victim, and that chart will serve as a record of the victim’s injuries, immediate treatment, and future treatment.

If injuries are not so severe that a hospital visit is necessary, the victim should go to an urgent care clinic or an approved doctor. The employer must post a list of approved doctors, and employees can choose anyone on this list. Workers’ Compensation claims could easily be denied when the accident victim has no record of their injury. The insurance company needs receipts if it plans to pay the claim, and there must be a record of all further treatment that is required.

Any reasonable person would be suspicious if an accident occurred and the victim never sought medical attention. If there is no record of medical care, the insurance company will not understand why rehabilitation is needed. Injured employees should allow a Workers’ Compensation lawyer to show that medical treatment was provided, or the employee was so impaired that they could not seek medical attention.

What If I was Blocked from Reporting My Injury?

Businesses that prevent their employees from reporting injuries are in violation of the law. There may be a case in which a manager wants to suppress injury reporting to make the division or department look good. The company might claim that the injured employee is not eligible because of their classification as a contractor. If the injured employee is immediately approached by a lawyer or representative of the company before even reporting the injury, they should hire a lawyer right away. Injured workers should not settle with the company before speaking to an attorney.

In some situations, a colleague may have encouraged the employee to avoid reporting the injury. There may be rumors in the office that those who report injuries are terminated, or a colleague might tell a story of losing hours or wages when reporting an injury. All of these cases should be handled by an attorney.

What If a Reckless Colleague Caused the Accident?

A reckless colleague may have caused the accident and injury as a result of their negligent or inappropriate actions. Although the employer cannot assume liability for the accident, the reckless colleague may be sued for damages. There are cases in which the reckless colleague reflects badly on the injured worker. The employer or the insurance company might believe that the injured party was involved in the inappropriate conduct that caused the accident when that is not the case. Therefore, it is important to collect as much information at the scene as possible.

What If I Work on a Dock, Ship, or Military Base?

Workers on docks, ships, and around military bases are covered under federal laws designed specifically for their jobs. The Defense Base Act covers those who work in a civilian capacity on a military base or government contract around the world. The Longshore and Harbor Workers’ Compensation Act (LHWCA) covers longshoremen who work on docks and in the shipping industry. These employees often do not work on ships specifically, but they are in the loading and unloading areas all day.

There are also long-standing maritime laws for sailors on ships. Those rules are codified in the Jones Act, which requires vessel owners to properly maintain and staff each boat. Defense contractors and longshoremen are covered under federal law, not state law. For example, someone who works on the banks of the Delaware River outside Philadelphia is covered by federal law, not state Workers’ Compensation laws. Families who lost loved ones will be eligible for death benefits, but they may not know how those benefits are supposed to be paid.

The Defense Base Act offers much leeway for injured employees and their families. Conversely, the LHWCA allows workers to file claims only when they are hurt on the job or performing their job duties. A longshoreman who is injured in a car accident while driving home from work would not be covered, but a longshoreman who is injured while driving a cargo truck for the company would be covered because they are still performing their job duties.

The Jones Act requires employers to provide a safe work environment and staff vessels properly. At the same time, it asks that employers provide maintenance and cure for injured sailors at sea. In addition to these rules, the Jones Act also allows injured workers and families of the deceased to sue the employer for damages when negligence is involved.

Are Death Benefits Available for Work Injuries?

Injured workers who die on the job or as a result of their injuries are eligible for death benefits. Death benefits are extremely important because they allow families to pay final expenses, pay off medical bills, and recover lost wages, where possible. If the insurance company or employer is resistant to paying these benefits, a lawyer should get involved.

The insurance company might claim that the work injury did not result in the employee’s death. When there is a question of how the worker died, the insurance company might not want to pay out immediately. A lawyer can request death benefits and build a compelling case to show that the family should be compensated appropriately.

When Should I Hire an Attorney?

Injured workers should hire an attorney when it becomes clear that they will not be allowed to report their injuries, their employer claims they are not eligible, or the insurance company wrongly denies their claim. Workers denied coverage will likely be upset, but there are options. A lawyer will speak to either the employer or the insurance company. Lawyers know how to speak to other attorneys who represent insurance companies or employers, and they can begin settlement negotiations where appropriate.

The families of injured workers should reach out to an attorney when someone has died as a result of injuries sustained at work. The family may have been denied death benefits, or they may need help paying the deceased’s medical bills. A Workers’ Compensation lawyer can review the case, determine the appropriate course of action, and avoid any issues that arise. Because these benefits have a two-year statute of limitations in Pennsylvania, it is important that families, victims, and lawyers work together as soon as possible.

Can the Insurance Provider Reverse Its Decision?

Insurance providers can reverse their decisions if they have been contacted by an attorney and presented with new evidence. Some denied Workers’ Compensation claims are the result of misunderstandings, improper reporting, or managers who simply did not know how to report the claims. All these matters can be settled easily.

Accident victims who were denied coverage have every right to be upset, but they cannot have the decision reversed on their own. Calling the employer to complain often does not help because the manager or insurance department is no longer in control of the claim. Employers pass on all liability to the insurance carrier.

Calling the insurance company does not help because the customer service associates or agents who take those calls do not have the authority to pay these claims. These people are looking only at information that has been passed down to them by their corporate office. Complaining or threatening a lawsuit will not improve the situation. In these situations, injured employees should allow a Workers’ Compensation lawyer to communicate with the business or insurance company.

Philadelphia Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Assist Injured Workers Who Have Been Denied Coverage

Speak to the Philadelphia Workers’ Compensation lawyers at McCann Dillon Jaffe & Lamb, LLC when you have been injured on the job and/or denied Workers’ Compensation coverage. We will review each case, let our clients know what can be done, and fight vigorously for every client’s right to compensation. Call us today at 215-569-8488 or contact us online for a free consultation. Located in Philadelphia, Abington, and Media, Pennsylvania; Wilmington, Delaware; and Haddonfield, New Jersey, we proudly serve injured workers throughout the surrounding areas.