WHAT HAPPENS IF YOUR EMPLOYER CONTESTS YOUR WORKER’S COMPENSATION CLAIM?

If you suffer a construction site injury or some other kind of workplace accident in Tennessee that keeps you out of work, in most situations your medical costs and a portion of lost income are covered through workers’ compensation insurance. Unfortunately, the theory behind worker’s comp doesn’t account for employers who don’t want to do what’s right.

Worker’s compensation is insurance coverage that employers must buy for each employee. Ultimately, worker’s comp claims cost an employer just like other insurance claims cost you – through higher premiums. This gives employers a financial incentive to deny claims or see to it that they are less costly. And workers’ compensation law gives them several opportunities to do so.

First, delaying your claim can stop it in its tracks. It is the responsibility of the injured employee to report any workplace accident or injury to their employer within 30 days of the accident or an injury diagnosis. It is important that you do this in writing. Do not rely on your boss or your employer telling you that they’ll take care of it.

Upon receiving your accident or injury report, your employer is to provide you a written list on a state-approved form of at least three local physicians. You may choose from among them, but you must see one of them, and that doctor will become the “authorized treating physician” on your case. You are then required to accept treatment from that physician and should not seek treatment from any other medical provider unless the authorized treating physician makes a referral. Again, don’t let anyone tell you otherwise. It could jeopardize your claim.

In order to obtain benefits, you must also submit a completed Request for Benefit Review Conference (Form C-40B) to the state Workers’ Compensation Division before the time limit runs out. Generally, that deadline is one year from the date of your injury.

Beyond torpedoing a claim at the start, your employer can contest the fact of your injury, or say your accident or illness was not job-related (which is required for you to be eligible for benefits). They could also argue the extent of your injury and your need for treatment.

For example, if you are injured in a car accident while on the way to a business meeting, this is a common occupational injury and you should be able to obtain workers’ comp. But, your employer could claim you were not authorized to attend the meeting, and were not traveling as part of your job. Would you be able to document the fact that you were supposed to attend the meeting?

If your employer disputes your need for medical treatment, you can appeal to the state Workers’ Compensation Division by completing and submitting a Request for Assistance Form (C40A). In addition to the information required by the form, you’ll need to attach “all pertinent medical information and relevant documents” for the Division to review.

Understand that an employer who is actively disputing your claim will have their own medical information and documents that support their side of the story. If the information you submit is not clear and complete, or has mistakes or contradictions, your employer’s argument could carry the day.

If you obtain workers’ comp benefits, these will be in the form of reimbursement for medical bills and weekly payments to match a portion of your lost wages. To cut this cost, you employer may claim you have recovered sufficiently and that it is time for you to return to work, maybe at a lesser position or for “light duty” that pays less. Your employer and its workers’ comp insurance carrier may be able to push the doctor assigned to your case to agree to “release” you for a return to work before you feel you are ready.

You can fight a medical decision you disagree with by obtaining a second opinion (at your own expense) and requesting a hearing. Here, you will try to persuade a hearing officer to decide in your favor. Your employer and his/her representatives will be doing the same.

These are just a few ways an employer can contest a workers’ comp claim, and your employer knows all about them. Or, if your employer doesn’t, their workers’ comp insurance carrier does. If you are the third party in this on your own, you may find yourself the odd man out when it comes time to work the system.

But at the Law Office of David E. Gordon, we put our knowledge to work for injured employees like you.

Whether you are at the start of a workers’ comp claim, have been denied benefits or are receiving benefits that your employer is trying to end, we can help level the playing field for you. Call us today to discuss your workers’ comp claim in a free, no-obligation initial consultation.