Tag Archives: claims

Why Is My Workers’ Compensation Claim Being Denied?

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Ideally, if you are hurt on the job, workers’ compensation should pay your medical bills and for any lost time because of that injury. If you are hurt bad enough, workers’ compensation should also pay your permanent disability, for future medical care and even for re-training.

In reality, sometimes this doesn’t happen. This post will attempt to explain the reasons why a workers’ compensation claim will be denied or delayed and what injured employees need to do preserve their rights.

  1. Lack of information: In order for a claims administrator or insurance company to pay a claim, they need to determine if it is covered by workers’ compensation. At a minimum, this means that they need some medical records documenting the injury. This can take time. If a doctor has given work restrictions, this means that the claims adjuster needs to contact the employer to find out if those restrictions can be accommodated. Even assuming everyone is being honest and diligent, this process may take a few weeks. The general standard is to give an insurer three to four weeks to investigate a claim. I would advise that injured employees be civil with employers and insurance adjusters. This can be difficult if you are like many Americans who live paycheck to paycheck, but a loss of temper can compromise your case. It’s difficult to be patient, but the fair employers and/or insurers will make up lost time pay and will pay you a reasonable amount of benefits without dispute and without the involvement of a lawyer.
  2. You aggravated an old injury or chronic condition: To be clear, if you make an old injury or chronic condition worse, that is covered by workers’ compensation in Nebraska. However, this may not be understood by a claims person in a state where there is a different standard of causation. This fact is also not widely understood by most employees or managers, which can lead employers to deny coverage and discourage employees from reporting such injuries.
  3. Your injury came on from overuse or repetitive use rather than from a one-time incident:  Arm, hand and even back injuries are very common from repetitive activity. These symptoms usually come on over time, and employees can’t pinpoint an exact injury date to employers or doctors. Under Nebraska law, such injuries are covered by workers’ compensation. But again an unscrupulous insurer and/or employer can use these facts to argue to you that your injury is not covered by workers’ compensation.
  4. You delayed seeking medical treatment: Delaying going to the doctor can hurt your workers’ compensation case, because it raises the suspicion that you hurt yourself outside of work. The delay doesn’t even need to be all that long. It’s a red flag if you claim you were hurt on a Friday then seek treatment on a Monday. There are all sorts of legitimate reasons for some delay, such as the inability to make an appointment, wrongfully thinking you need to ask permission to see a doctor from your employer, seeking treatment with company nurses first, or even thinking an injury will improve on its own. A lawyer can make those arguments with some success, and you should contact one if this is an issue in your case. But the longer you wait to see a doctor, the more likely it is your claim will be denied.
  5. You didn’t tell your supervisor you were hurt, or you didn’t fill out an accident report: If you are hurt at work, your employer has a duty to report to the state of Nebraska and the Occupational Safety and Health Administration (OSHA) that you were hurt. You also have a duty to inform your employer as soon as practicable. Cover yourself, and report the injury. Even if your employer doesn’t have a form or a formal human resources department, send a text or e-mail to your boss telling that person what happened and what kind of injuries you have.
  6. You initially denied you had a work injury: Some employers will tell you that they will take care of the injury themselves and not turn it in to workers’ compensation. In some cases, employees are afraid to turn in injuries. In other cases, an employee has been led to believe that an injury isn’t covered because of the factors listed in points 2-5, so that worker turns the claim over to private insurance. The problem with this outcome is that for a serious injury you can get stuck with paying a lot of money out of pocket, which can be almost impossible to pay if you aren’t working and not receiving workers’ compensation benefits. Even worse, some health insurers will reverse payment if they get an indication your bills should have been covered by workers’ compensation. Some companies have private disability policies that might allow you to collect some benefits, but those policies will also deny benefits if they have some indication that there was a workers’ compensation claim.If you are in this situation, you need a lawyer for your workers’ compensation claim. You also need a lawyer who knows creative ways to turn the tables on employers and insurers who completely deny benefits to their employees. Some of my most professionally satisfying cases have come from turning the tables on employers who, for lack of a better word, jack around employees who make some mistakes in how they handled their workers’ compensation claims.
    Even if you have done several things to hurt your workers’ compensation claim, a good lawyer can take actions to get justice on your claim.
  7. Your employer didn’t fill out an accident report or filled it out wrong: Not all denials or delays are due to mistakes made by employees. Employers drop the ball as well. That’s why you want to cover yourself with your own written report as well as see a doctor as soon as you can and be sure to tell that doctor how you were hurt.
  8. You were treated by a physician assistant or nurse practitioner:  Some insurers and/or employers believe that physician assistants and nurse practitioners cannot testify in a workers’ compensation case in Nebraska. I strongly disagree, but the issue has never been definitively decided by an appellate court. An aggressive employer and/or insurer will use this as an excuse to not pay benefits. A lawyer can help fix this issue by asking a supervising physician or D.O. to give an opinion in your case.
  9. You went to see your own doctor rather than the employers’ doctor: Unless your employer gives you notice AFTER your work injury, you have the right to be treated by your doctor. You don’t have to see the doctor at the clinic where your employer sends you to be drug tested after an injury.
    I despise few phrases more than “workers’ compensation doctor.” Any doctor can treat you for a workers’ compensation injury. A “workers’ compensation doctor” or an “occupational medicine doctor” is just a doctor who is happy to fill out the extra paper work required in a workers’ compensation claim. Usually these doctors work hand in glove with employers and insurers. Sometimes this works out for employees, but many times it doesn’t. Unscrupulous or unknowledgeable insurers and/or employers will deny care to employees who pick their own doctors. Sometimes employers will take action against employees as well. In cases like this, you need a workers’ compensation and employment lawyer.
  10. Your employer blames you for your injury: Unless you were intoxicated when you were injured, the issue of fault is irrelevant in a workers’ compensation claim. If your employer is denying your claim based on you being at fault, you need a lawyer for your workers’ compensation claim and one that can evaluate a potential employment-law claim.
  11. You are being denied benefits because you were fired or quit:  Like the issue of fault for your injury, the fact you were fired or quit post-accident should have little impact on your workers’ compensation claim, but you should contact a lawyer who can advise you on workers’ compensation and employment law.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Workers' Compensation and tagged , , , , , , , , , , , .

How to File a Safety and Health Complaint

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Today’s post was shared by the U.S. Department of Labor and comes from www.osha.gov

 

How to file a complaintIf you suspect an OSHA violation has happened at work, it’s important to report it by following the steps listed at the website below. If you have questions about reporting a violation, please contact us, and we can help point you in the right direction. In addition, many of OSHA’s inspections occur because of injuries, so if you or a loved one is injured at work, please contact an experienced workers’ compensation lawyer who can make sure the appropriate OSHA reports, as applicable, are considered in your case.

The Occupational Safety and Health Act of 1970 gives employees and their representatives the right to file a complaint and request an OSHA inspection of their workplace if they believe there is a serious hazard or their employer is not following OSHA standards. Workers do not have to know whether a specific OSHA standard has been violated in order to file a complaint.

Complaints from workers or their representatives are taken seriously by OSHA. OSHA will keep your information confidential.

[Click here to see the original post]

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in OSHA, Workplace Claims, Workplace Injury, Workplace Safety and tagged , , , .

State Laws Determine Worker’s Rights: Work Comp Benefits, Process Vary by State

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Many workers are hired in one state but are required to attend orientation or participate in a hiring process in another state because their potential employer is principally located and doing business there. Once they are hired and accept the job, they are then required to work in another state for various reasons. In these situations, many workers do not realize that a different state’s laws could apply to their workers’ compensation claim if they are injured in a state that is

  1. different from where they were hired,
  2. different than where they accepted the job,
  3. different from where their employer is principally located or performing work, or
  4. even different than where they currently live. 

If you have been injured in another state, you may be eligible to have your workers’ compensation benefits determined by another state’s laws. This is important, as the benefits you could be entitled to are different in every state. In certain respects, the differences are significant in terms of the amount of weekly benefits, permanent benefits, or type and duration of medical care you may be able to receive.

The right to choose your family physician to treat you for your injury or the amount and duration of the disability benefits you may be entitled to are significantly different in every state. Let’s consider a few pairs of cities:

  • Omaha, Nebraska & Council Bluffs, Iowa
  • Sioux City, Nebraska & Sioux City, Iowa
  • Nebraska City, Nebrsaka & Harlan, Iowa

These cities in different in Iowa and Nebraska border each other, and a great number of residents from one are employed and work in the other. If you are injured in one state but live in another, and depending on where you were hired or where you were when you accepted the employment, you may have a Nebraska or Iowa workers’ compensation claim, or even both. 

Nebraska

If your employment or your accident has any ties to the state of Nebraska, your employer is required to file a First Report of Injury with the Nebraska Workers’ Compensation Court. When this occurs, it is common for the Nebraska Workers’ Compensation Court to actually mail you a copy of your own First Report of Injury that was filed with the court by your employer. Just because a First Report of Injury was filed in Nebraska and just because the Nebraska Workers’ Compensation Court sends you a copy does not mean you are limited to Nebraska for the benefits that you may be entitled to. 

Iowa

It is also normal for an insurance carrier of the employer to mail you a letter that says, “Your employment agreement, whether in writing or made in person, required your accident to fall under Iowa law,” or some other state’s law. Generally, no one has the right to decide for you which state your case can be determined in. It is a question of each state’s laws that determine where your claim can be processed.

Nebraska and Iowa

As a matter of general practice, if your accident occurred in that state, your claim and benefits can be determined based on that state’s laws. Other things like where your employer is principally located or where your employer regularly performs work can determine if you have a claim in each state. Further, your contract of hire or where you accepted the employment can also play a part, as well as where you were residing at the time of your accident in relation to where your employer was performing work, can also determine which state you may have a claim in. 

These things, as well as what type of benefits each state allow, could make it possible for you to file in both states.

Time Periods to File in Each State

Each state has a certain time period in which to file a claim or action in the compensation court. 

  • In Nebraska, you have two years from the date of accident OR two years from the date of any payment (weekly disability check, medical bill, mileage, prescription) in which to file an action in the compensation court. 
  • In Iowa, a person has two years from the date of accident OR three years from the date of payment of a weekly disability benefit check in which to file an action in the compensation court.  

Beware, however, that payment under one state’s laws may not save your claim in another state. For example, a payment under Iowa law will count toward a payment in Nebraska. However, a payment under Nebraska law will not count toward a payment under Iowa law.

Award, Order or Settlement Agreement for Benefits

It is important to note as well that an award, order or settlement can affect your right to file a claim in another state. 

For example, if one obtains a Court Award, Order or Settlement in Nebraska, this would prevent you from obtaining any benefits in Iowa, if you had the option of pursuing benefits in both states. 

On the other hand, if the same person obtained a Court Award, Order or Settlement in Iowa, a person could still pursue additional benefits in Nebraska that are different than what was provided in Iowa.

In both states, the insurance carrier would be entitled to a credit for what they paid in the other state, but you would still have the opportunity to pursue different and additional benefits in the other states, potentially.    

Summary

The differences in law issues are often very complex. Whatever your situation is, if you think there might be any question as to which state’s laws apply to your case, you should speak to an experienced attorney who can advise you about the laws in each applicable state.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Iowa, Nebraska, Workers' Compensation and tagged , , , , .

Work Comp Approved My Medical Care; Why Am I Still Getting Billed?

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Sometimes insurance companies do the right thing in workers’ compensation claims but medical offices don’t. A prime example of this is overly aggressive billing for medical services.

Under Nebraska law, an employer may only charge a certain amount for medical care covered by workers’ compensation care. Most importantly, the injured worker should pay nothing for medical care if it is covered by workers’ compensation. In Nebraska, workers’ compensation generally pays doctors a higher rate than private insurance.

The problem is that sometimes clinics will try to collect the balance from injured workers under the assumption that workers’ compensation works like private health insurance. Injured workers who get their care paid for by workers’ comp aren’t subject to deductibles or co-pays.

Sometimes clinics just make stupid mistakes.  I recently had a client who was billed by a surgical office for the expense of the employer’s lawyer meeting with the surgeon. Today, I had a client who was being flat out doubled billed.

Even if you are getting your medical paid, it would make sense to speak with an experienced workers’ compensation attorney in a scenario when you are being overbilled for care related to workers’ compensation. The same also goes if a medical office is aggressively trying to collect an unpaid bill from you. A knowledgeable lawyer can fight an unjustified collections case and can also advise you about your workers’ compensation.

Oftentimes, financial problems related to workers’ compensation injuries stem from an employee not getting loss-of-income benefits while they are healing. I defended a collection action for a client who was forced to use his wife’s health insurance to pay medical bills for his workers’ compensation-related medical bills. Having the ability to successfully prosecute a workers’ compensation case can relieve those financial pressures in some circumstances.

The offices of Rehm, Bennett, Moore & Rehm, which also sponsors the Trucker Lawyers website, are located in Lincoln and Omaha, Nebraska. Five attorneys represent plaintiffs in workers’ compensation, personal injury, employment and Social Security disability claims. The firm’s lawyers have combined experience of more than 95 years of practice representing injured workers and truck drivers in Nebraska, Iowa and other states with Nebraska and Iowa jurisdiction. The lawyers regularly represent hurt truck drivers and often sue Crete Carrier Corporation, K&B Trucking, Werner Enterprises, UPS, and FedEx. Lawyers in the firm hold licenses in Nebraska and Iowa and are active in groups such as the College of Workers’ Compensation Lawyers, Workers' Injury Law & Advocacy Group (WILG), American Association for Justice (AAJ), the Nebraska Association of Trial Attorneys (NATA), and the American Board of Trial Advocates (ABOTA). We have the knowledge, experience and toughness to win rightful compensation for people who have been injured or mistreated.

This entry was posted in Workers' Compensation and tagged , , , .