Taking a look at contested workers’ compensation claims

Posted November 6th, 2014 by .

Categories: Workers Compensation.

workers-compensation-claim-denied-lawyerIn many instances, workers’ compensation cases are routine ones.  They involve approval of authorized medical care, as well as reimbursement for lost wages.  In some cases, there may be money due for partial or total disability benefits.  However, what happens when the employer or its insurance company disputes the claim?  Is there a process in place for contested workers’ compensation cases?

First, it is advisable to seek legal advice when you are injured at work.  It may not be difficult to get the insurance company to authorize medical care.  However, it is important to know that if you want the bills paid, you need to treat with their doctors.  The same goes for reimbursement of lost wages.  If their authorized treating doctor directs you to stay out of work, the insurance carrier will likely set up payment for lost wages.  Unfortunately, this may take time and an attorney can help with the process.  More than likely, the insurance company will not voluntarily make an offer for partial or total disability.  It takes an attorney to negotiate this part of the claim.

The real issue occurs when the claim is denied.  In some cases, the employer may say that you never worked for them.  They might opine that your injuries occurred outside of your employment.  Perhaps there are questions of whether your problems are causally related to your job.  There may be a dispute about the time frame of your accident.  There could even be a question of whether your symptoms are actually part of a disease that has nothing to do with the employer.  There are many reasons why a workers’ compensation case is denied.

What happens next is our attorney will file that same procedure used to process accepted claims.  At the Law Offices of Anthony Carbone, we recognize the importance in securing medical treatment and reimbursement for lost wages.  We will attempt to work with the insurance company to see that both are available to you.  If your claim is denied, we will file the necessary paperwork so that a state or private disability plan will pay you in the interim.  We will also communicate with doctors concerning your case.

Once the case reaches court, our law firm will negotiate with the insurance company’s lawyers.  In some circumstances, it may seem advisable to wait until your case is called to trial.  Otherwise, we may attempt to settle under a provision of the law known as “Section 20.” A case settled under Section 20 is reserved for disputed cases.  It means that the insurance company has agreed to pay a lump sum payment to close the case.  Medical bill payment is part of the amount considered in this type of settlement.  It also is a final dissolution of the case.  You cannot go back to the insurance company for more money if you suffer issues in the future.

If you have a workers’ compensation claim that was denied, contact the Law Offices of Anthony Carbone for a free consultation.

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