Top 10 Ways To Avoid A Denied Claim


The only thing worse than getting injured at work, is getting injured without the injury being covered by your insurance. The following list covers some of the major pitfalls people encounter after they file a Texas Workers’ Compensation claim. 1) Report the injury as soon as possible. a) If a claim is denied, the sooner it was reported, the easier it will be to resolve. b) Especially with occupational diseases (repetitive motion injuries), the date of injury and timely reporting generally become issues in the claim.

2) Get written statements from any co-workers that know relevant facts. a) Co-workers are a lot more likely to write something down when there is no dispute and they are not concerned about retribution from the employer. b) Just a one or two line hand written statement like “I saw John trip over a pallet” will suffice.

3) Make sure your employer creates a written report, even if it doesn’t appear to be serious. a) Many supervisors are busy. If a report isn’t created they may forget. b) Some companies have policies that the supervisor may be written up for not creating a report, creating the chance that the supervisor may lie to protect their job. c) A written report creates a clear paper trail and may provide written notice to the insurance carrier.

4) Be as clear as you can when describing how the accident occurred. a) If there are different versions as to how the accident happened, insurance carriers will use this to deny the claim b) Always check how your employer, medical providers, insurance carriers and law firms describe the accident. Make sure they are being accurate. c) Specifically in your recorded statement, do not let them confuse you.

5) Acknowledge any prior accidents. a) The insurance company will run a record check to see what other work or auto injuries you have had. b) Most of the time a prior accident will not affect any new injuries.

6) Have a medical exam with a doctor that is not the company doctor as soon as possible. a) If a clinic states that they only need the most serious condition and will treat the other conditions later, do not trust them. b) A medical provider that has the patients interest will list all the conditions, even if some require attention first

7) Maintain a calendar noting the dates of events. a) A calendar will log the events of your injury, so you don’t have to guess after time has passed.

8) If you’re able to continue working, do so. a) You will earn more from your salary than from disability. b) Being active (as long as it doesn’t make the injury worse), usually speeds up recovery.

9) Follow through with your medical treatment. a) The diagnostic tests and physical therapy from your medical provider are the clearest indication of an ongoing injury. b) If you abandon your medical care, it will be assumed that you are at maximum medical improvement, which could end your disability benefits.

10) Get an attorney involved as soon as possible. a) An attorney will help you avoid traps created by the insurance carrier. b) Attorneys do receive a percentage of your benefit. But, most of something is always better than all of nothing. c) Call (214)357-1782 for assistance. If your near the Dallas Fort Worth area make an appointment to see if we can help you.


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