What Happens if the Insurance Company Disputes My Workers' Compensation Claim?
There is a big difference between an initial denial and a final denial.
If the insurance company disputes a worker's compensation claim, things look bleak at first. Initial denial rates, which have always been high, have increased by 20% since 2018. When students get bad grades, there is usually something wrong with their essays. So, most people assume that when a Claims Examiner denies a claim, that claim is flawed.
Usually, however, that is not the case. An initial denial simply allows a Tampa worker's compensation lawyer to appeal the matter to a more competent Administrative Law Judge. Unlike Claims Examiners, who usually just review medical bills and look for technical flaws, like missed deadlines, ALJs examine every aspect of a worker's compensation claim. So, in this part of the process, a well-prepared Tampa worker's compensation lawyer, not an insurance company lawyer, has the advantage.
Building a Claim
We mentioned medical records above. In most cases, medical records are the foundation of a worker's compensation claim.
Most job injury victims in Florida must see company doctors. So, initial medical records are often slanted in the company’s favor. As a result, a Tampa worker's compensation lawyer must try a little harder to build a claim. The additional effort is more time-consuming, but the extra investment pays off in the end.
This additional effort usually includes a partnership with an independent doctor. Job injury victims must see company physicians, but like all other patients, they are entitled to second opinions.
Usually, an independent doctor starts by reviewing the existing medical records, including proposed illness or injury treatment, and determining if more (or less) treatment is needed. Independent doctors usually physically examine victims as well. Then, if the situation dictates, the doctor begins a treatment regimen.
Usually, these doctors charge nothing upfront for their professional services. Other providers, such as diagnostic clinics, usually extend the same courtesy.
An independent doctor partnership is usually the minimum effort necessary. Minimum effort usually yields minimum results. Going the extra mile makes a big difference.
In job injury cases, the “extra mile” usually means collecting statements from friends and co-workers. These individuals cannot testify about the medical aspects of an injury or illness. But they can testify about how that injury or illness affects a victim, giving vague injury or illness symptoms a human face.
Resolving a Disputed Claim
Most worker's compensation claims, even those that insurance companies dispute, settle out of court. These resolutions are good for job injury victims in several ways. For example, settlements are final resolutions. When insurance companies settle cases, they immediately write checks.
Settling worker's comp claims is a little more complex than settling civil claims. ALJs have limited authority, and they do not have the power to force parties to negotiate in good faith. Therefore, low-ball and “take it or leave it” offers delay the worker's compensation settlement process.
So, your lawyer must be a good negotiator, as well as a good litigator. Good negotiators know when to stand firm and when to compromise.
Contact a Diligent Pasco County Lawyer
Victims need and deserve compensation for their serious injuries. For a confidential consultation with an experienced worker's compensation lawyer in New Port Richey, contact the Rooth Law Firm. Mr. Rooth is a Board-Certified attorney in workers' compensation law by the Florida Bar Association, a distinction that fewer than one percent of all Florida lawyers have.