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Why workers' comp claims get stalled (and what to do about it)

When your job puts your health in jeopardy, you shouldn't have to wait forever to get the treatment and benefits you deserve. Employers and insurers must act quickly to process your requests.

Unfortunately, workers' compensation claims sometimes get lost in the shuffle. Your employer, the insurer or both may be responsible for delays that infringe on your rights.

The following are common reasons why claims get delayed:

  • Your employer dropped the ball: After you report a work-related injury or illness, your employer must provide you with a claim form, forward the claim to their insurance administrator, authorize medical treatment and take certain other steps to advance your claim - all within a swift time period. If your employer hasn't fulfilled these responsibilities, you may need to involve a lawyer to get things moving.
  • Your requests for treatment were ignored or denied: You don't have to wait until your claim is processed to get medical treatment. You're entitled to up to $10,000 in medical coverage while your claim is pending. What's more, when your doctor requests approval for surgeries and other treatments, the insurance company must act quickly to process these requests. You can ask for an expedited review in urgent cases. If the claims administrator misses the deadline, your treatment will be automatically approved. If your treatment is denied, you can request further review through the Independent Medical Review (IMR) process, which likewise has strict deadlines.
  • The insurer is disputing your claim: If the insurance company doesn't agree that your condition is work-related - or if they dispute the nature or extent of your injuries - you may have to undergo evaluation by a qualified medical examiner (QME). The QME process can have a major impact on your benefits. If you don't yet have an attorney, now is the time to involve one.

These are just some of the hurdles that contribute to delayed claims. There may be countless others. The best way to make sure you get the treatment you need, when you need it, is to enlist the help of a qualified attorney as soon as possible.

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