In the United States, the oldest insurance plan is known as workman's comp pay. If workers get injured during the duty hours, they can get benefitted from the compensation pay. Conferring to workman's compensation pay, workers can also receive partial wages whilst they recover from the injuries. In the US, many states have made workers's comp pay an obligation which every business should abide by; however, there are some situations in which workman's comp won't pay that are going to be discussed in the article.
Reasons – Why Workman's Comp Won't Pay
All businesses are obliged to pay workman's comp, but most of the time employers deny providing compensation and due to the complexity of the process, it can be a nightmare to the worker's family to do claims after the injury.
It is found that the overall denial rates to workman's comp have been increased up to 20 percent in the last five years (see chart below). It is significant to bring into the notice that there is an increase in both types of denials; denials that stick at 12 months and denials that converted, after a complaint, at 12 months.
Following are some reasons that lead employers towards the denial of workman's comp pay.
Workman's comp won't pay because of the failure to instantly notify authorities about injuries.
When workers are injured during the work, they shall inform their authorities regarding their injury, while clearly describing the causes of injury. Failure to inform authorities on the injury is the reason why most of the companies do not disburse workman's comp. Laws for worrkers's compensation pay differs in different states of the US. Most of the states do not consider the request of compensation pay after 30 days. However, this time varies from state-to-state so it is possible that some states might have the deadline for workman's pay set at 15 days. The legal deadline for filing the workman's com is known as the Statute of Limitation period. Remember, there is a difference between reporting the injury and filing the claim for your injury. The deadline mentioned in the text is for filing the claim – i.e. Statute of Limitation
Workman's comp won't pay because they won't know there is any claim.
In most cases, workers do not inform their supervisors or authorities because they think they have seen them getting injured or another worker was with them during the injury. If you won't make a claim or report your injury through a proper channel insurance companies would keep denying workers comp pay.
Workman's comp won't pay because they do not believe that your injury took place at work.
After the injury, when a worker is headed towards the doctor, it is conceivable that the doctor won't believe that a worker got injured during the work. This, however, happens because the worker, sometimes, is not precise about how the injury took place and what instigated the injury. For example, a worker asked the doctor that his or her foot is hurt; the doctor won't know what caused the injury until and unless the worker is specific about the injury. The injury could alternatively be defined as, sir whilst I was heading towards a storeroom to take some equipment, my foot got bumped into the door. Such unspecific details might lead employers not to pay workman's comp.
Workman's comp won't pay for soft-tissue injuries.
The problem arises when workers demand compensation of contusion and problems related to the damage of soft-tissue. Contusion and soft-tissues problems are most common in every type of work from sitting on a chair for more than 8 hours to work tirelessly in the field.
What to do When Workman's Comp Won't Pay?
Following are the processes that a worker must follow to avoid the denial of workman's compensation pay.
- All workers must notify their authorities as soon as they are hurt and they must claim for workman's pay within the given time-period otherwise insurance company would not be liable to pay workman's comp and can deny the claim made by the worker. Period and inability to comply with the deadline might lead the employer to deny from paying workman's comp.
- If a worker will enlighten his or her supervisor immediately about their injury, the supervisor will make the report for workers's pay and then the report will be forwarded to the concerned authorities for further processes. Once the report is forwarded to the insurance company, they would process the request for workers's compensation pay. Therefore, if a worker is injured during the work, he or she must promptly approach the authorities and bring them in the confidence so that any worse condition can be faced unitedly.
- After explaining everything to the medical doctor, it is important to the employees to ask the doctor to write a note on the paper that this injury is caused by the work so that the worker can request for workman's comp pay. If a doctor refuses to consider this injury as a workplace injury, the worker can opt for a second opinion from any other doctor as well.
- Insurance companies are not easily convinced about soft-tissue injuries and non-physical diseases. If companies refuse to pay worker's comp for these injuries, workers can seek the help of the court. However, the worker will need to defend his/her case as to how this soft-tissue injury or mental health is caused during the work. If the case is successfully defended, the court will give its ruling in favor of the worker.
It is very frustrating to know that workman's comp payment is denied by the insurance company, especially if the worker has done everything from instantly notifying their authority, explaining his or her problems to the doctor to filing a complaint about workman's compensation pay. In this case, the worker can lodge a complaint against the company in the court. Once the matter is in the court, the court reserves the rights to give its verdict on worker's comp pay – by reviewing all the documents – in favour of the worker.
The worker may also seek help of law expert before going to the court to know whether his/her request to review the case would be considered or not. Through this, he/she will also get an idea about what counts for worker's comp pay and what not.
However, there is a time limit to lodge a complaint against the insurance company, if you will miss the deadline, your request will not be considered by the court. The time limit to lodge a complaint, across the US, is between 30 to 90 days. So, the worker needs to keep this in mind, in case of the denial of his compensation request from the insurance company. In case of failure to lodge a complaint between the deadline periods, the worker won't be able to take his case to the court.
Many states in the US have laws for workman's comp pay, but workers still face problems while claiming it. In some cases, insurance companies create hurdles for a worker and in some cases worker's show laziness while claiming for the compensation. Workers do not inform their authorities promptly, which leads them to face these hurdles. Sometimes, workers make a request for compensation but do not claim for it.
Companies, sometimes, believe that the injury is not caused by the work if workers have a contusion in tissues. In all the cases, workers can lodge a complaint against the insurance company or he/she can seek the assistance of a legal advisor. Through this, the workers can make insurance companies pay workman's comp. However, the worker must do all the things mentioned in the article in order to reduce the probability of denial for workman's comp payment.