What to Do If Your Workers Compensation Claim Is Denied
Workers compensation is something people seldom need. In fact, most workers won’t ever suffer a job related injury, and need to file a claim. However, when it happens, then it’s usually a serious issue. An accident occurs and you risk being without salary for a while, plus medical bills, so you always want your claim to be processed quickly. But not all claims are honored. What do you do if your workers’ compensation claim is denied?
The first thing to do is to look at the denial paper. Typically when you get the result, a report will be sent to you that explains how the review process went, and the reasons for rejection. In some cases, it may be a simple error, like you didn’t fill in the form properly, or didn’t include all the documents that were requested. In these cases, it may be possible to correct the issue quickly, and resubmit the paperwork. If not, then the next step to think about is an appeal. You can always appeal your rejection, and they will need to review the claim again. It may be that whoever reviewed your claim didn’t read everything correctly and made a mistake. Perhaps you actually weren’t covered, in which case they will deny it again. But sometimes, valid claims are denied simply because the employer doesn’t want to pay.
Effective Ways to Reduce Workers’ Compensation Claims and Related Costs
Workers’ compensation insurance safeguards the employees, injured in the course of employment. In many states of US, it is a mandatory policy and is required by every company with employees.
Despite of all the preventive measures, instances of workplace injuries are increasing every year, forcing the business owners to spend huge amounts on compensation claims. According to U.S. Bureau of Labor Statistics (BLS), nearly 3.1 million non-fatal workplace injuries and illnesses were reported among private industry employers in 2010.
Hence, it is necessary for every employer to implement effective safety measures, not only to reduce compensation claims, but also to improve workplace safety and employee security.
Employing a comprehensive program, tailored to suit the organization’s specific needs and goals, helps the organization decrease the frequency as well as the severity of injuries at workplace. Following are few ways that can help you in establishing a risk free workplace, which further aid in reducing workers’ compensation claims and related costs.
Implement risk controlling measures
Employees working in industries, manufacturing plants, construction sites, etc., are often prone to on-job injuries and accidents. Working with heavy equipment using hazardous material raises employee safety concerns. Hence, every employer needs to follow a series of steps to improve workplace safety. These steps include – risk identification, risk assessment and risk control.
• Risk identification is identifying the possible hazard/risk. A hazard is anything that could hurt the employee or any other third party. For example, damaged or frayed electric cables are potential sources of accidents at workplaces.
• Risk assessment involves finding of all the potential outcomes of identified risks/hazards and the seriousness of the damage they could cause. In the above mentioned example, frayed electric cables, the harm could be an electrical shock.
Professional Indemnity Insurance and Quality Risk Management Is Essential for SMEs
Gaining a competitive advantage can remain the major focus for SME professionals who protect themselves appropriately. Risk management can save a business a lot of hassle and finance, whereas professional indemnity (PI) cover can cushion the blow of the sometimes unavoidable issues and incidents.
Health and safety protocol, regular inspections, training programmes for staff – risk management can seem like a complex process. All managers need to consider risk management as a fundamental component to the day to day running of their business. If it is neglected, insurance premiums can rise and employers can be held liable for all kinds of claims – claims which are on the rise anyway.
The Insurance Times recommend brokers’ assistance can help when placing cover. Brokers have experience in dealing with multiple organisations and therefore also have the ability to level SME risk management against similar, or even larger, companies across various industries.
Service providing organisations can only control so much of their business though and professional indemnity insurance can protect them from claims of negligence against their duty. A lot of these claims can be false but with the right cover, SMEs can stay focused on their business objective, rather than sparing more time and budget than they need to, going through the legalities of a claim.
If a customer or client believes they have incurred a loss or damage due to the negligence of another party, they are within their rights to claim. PI insurance should protect the accused, whether they are guilty of negligence or not, for any losses up to the settled insurance amount.
How To Know If You Qualify For Workers Compensation Benefits?
Many people often have questions about worker’s comp and whether their injury may be covered by worker’s compensation benefits. Worker’s compensation, which is frequently known as Worker’s Comp, is the name for a set of laws intended to provide protection to workers who are injured on the job. The primary goal behind this system of laws is to ensure that anyone who is injured on the job receives not only medical care, but also wages that are lost as a result of the injury. In some cases, the injured worker may also be able to receive rehabilitation and training to allow them to return to the workplace. In the event a worker is actually killed while on the job, members of their families are typically eligible to receive their benefits.
In determining whether one is eligible for worker’s compensation benefits, it is important to understand that Worker’s Compensation is actually a state program. Generally, benefits are extended in most states to cover workers regardless of whether the fault is on the park of the employer or the employee. Furthermore, in some states, the employer is mandated to purchase some type of coverage; however, state laws may vary regarding the percentage of the injured worker’s wages must be paid by the employer as well as the duration of the coverage. It should also be noted that in some areas, workers may be prohibited from collecting worker’s comp benefits if the injuries they sustained resulted from intoxication or willful misconduct.
Laws regarding state worker’s compensation can vary significantly regarding the types of work-related injuries and employees that are actually covered. For instance, the following groups are typically excluded from worker’s compensation benefits coverage:
- Volunteer workers
- Contractors
- Domestic servants
- Consultants
- Farm workers
Virginia Workers’ Compensation and Social Security Disability: Is the Disability Test the Same?
You are injured at work and you wonder if you qualify for both Workers’ Compensation and Social Security Disability. You would like to get both benefits but can you get both benefits at the same time and is the disability test the same?
First, Virginia Workers’ Compensation is a program to pay the injured worker who suffers an injury on the job. Generally, Workers’ Compensation Insurance pays two thirds (2/3) of one’s salary. It is non-taxable. It also pays for medical bills caused by the accident. Any employer in Virginia who has two or more employees is required to have workers’ compensation insurance. If the worker due to the injury is unable to perform the duties of his occupation, then the insurance company will pay “compensation” to the worker based on two thirds (2/3) of his salary. Generally, the worker does not have to be “totally disabled” rather the worker due to his injury must just be “incapable’ of performing the duties of his/her job. Injury compensation in Virginia is governed by the Virginia Workers’ Compensation Commission. If there is a dispute between the injured worker and the insurance company over his/her disability status that dispute is resolved by a Deputy Commissioner at the Commission in an administrative hearing.
Second, Social Security Disability (SSD) is a federal program and is not run by states such as Virginia. Its benefits are a monthly stipend based on the worker’s earnings records and Medicare after receiving the stipend for two years. Generally, unlike a workers’ compensation claim, in a SSD claim the worker will have to show he or she is “totally disabled” for work. The definition of disability Social Security uses is a disability that has lasted can be expected to last more than twelve (12) months which prevents you from earning more than $1,000.00 a month. If SSD is initially refused, your case will ultimately be decided by a federal administrative law judge in a hearing.