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Workers Compensation Lawsuit
Originally intended as a means of minimizing litigation and providing employees with a well intended financial security resource in the event of unforeseen work related disability, injury or other loss cause for loss of income while performing duties or tasks on the job, workers compensation insurance today has grown to become an often inefficient process that oft times is best suited for attorney oversight from the start.
If you have been denied workers compensation, hiring an attorney is your best option.
In recent years, state governments have made significant changes to workers compensation laws in an effort to combat workers comp insurance fraud in response to insurance industry demand for better protections from workers comp insurance fraud schemes.
Although fraudulent claims account for less than 3% of all workers comp insurance claims, this percentage represents a significant loss for the insurance industry where total losses to fraud exceed greater than 80 billion per year across the industry.
While most insurers operate under well intended protocols and processes, some come companies may unfairly use national insurance fraud statistics to unfairly deny workers compensation benefits to employees and families at what is usually one of the most difficult times in their life.
Workers comp claim denial reasons may vary from state to state under coverages from the same provider based on geographic location and variables related to employee injury.
Common reasons used in denying your right to financial help for you and your family are:
False workers compensation claim. These are claims where an employee has fabricated outright his or her work related injury. This type of workers comp claim denial is conclusive and straight forward as to reason for workers comp claim benefits being denied. The insurer or employer has determined that the injury used as grounds for claims to benefits either never occured at all or occurred under circumstances unrelated to the employees performance of his / her job duties.
Receiving or applying benefits while currently working. Workers compensation benefits are intended to provide financial help to employees when they are unable to work and earn wages. If they are found to be working at another job or the same job where the injury used as grounds for the claim occurred, benefits are usually denied as the employee is determined to be capable of earning his / her wages.
False representation of injury or exaggerated claim. In these instances, the workers comp insurance provider or employer has determined that the injury used as basis for the claim does not meet requirements for filing the claim. When employees exaggerate the severity or nature of their injuries and those injuries impact on ability to work, the claim will usually be denied on these grounds.
Workers compensation fraud through payroll inaccuracies such as underreporting and accidental miscalculations. This type of business level fraud is not usually caused by employees. Business owners and managers at various levels may have unrelated reasons for payroll and accounting fraud.
Regardless of reason, workers filing legitimate workers comp claims should not be denied benefits based on the actions of others.
The good news is that denied workers comp claims are not final. Employees have have rights beyond those specified under workers comp coverages. Specifically, workers have the right to hire a workers compensation lawyer to represent them in their effort to secure workers comp benefits.
Although attorney assisted workers claims are statistically more likely to take longer to resolve, they are also statistically more likely to produce better results with higher monetary benefits.
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