Problems That Often Occur When Receiving Workers' Comp Benefits

While most Mississippi workers are entitled to receive workers’ compensation benefits if they are injured on the job or have a workplace-related illness, there can be difficulties inherent in receiving the benefits owed. Some of the more common problems workers may face include the following:

• The worker’s claim may be deemed invalid. The employer or insurance carrier may claim the injury or illness was not directly tied to the employment. While the goal may be to limit the number of bogus claims which are filed, employees with legitimate work-related injuries or illnesses may be denied benefits they are entitled to.
• The employer may exhibit a failure to follow up with the workers’ comp claim, or the employee may not have properly followed the reporting procedure. Both employees and employers should have a good understanding of the reporting process for workers’ comp claims.
• Reporting the claim too late can result in a denial of benefits. The employee has thirty days from the date of the work-related injury or illness in which to notify his or her employer.
• No Return to Work Program. Far too many workers are not given access to a Return to Work Program. Getting an injured worker back to work (once he or she is deemed ready to return to work by a physician) is important for employers and employees. A RTW program provides step-down positions within the place of employment, keeping the employee involved and reducing the overall cost of claims.
• Employee failed to secure names of witnesses. In a close workers’ compensation case, having witnesses who actually saw your accident at work occur can be crucial.
• Employee failed to get medical treatment. This is one instance where “bucking up” and saying you are fine can really come back to haunt you. If you are hurt at work—no matter how minor or insignificant you believe your injuries are—you should seek immediate medical attention. Go see your own physician, go to a walk-in clinic, or ask to be taken to the nearest emergency room. Insurance companies will assume workers who failed to seek immediate medical attention weren’t really hurt all that badly.
• Employee failed to explain to the doctor how they received their injuries. If the initial medical records do not adequately describe the work accident and subsequent injuries, the claim could be denied. Explaining to the employer, as well as the physician, exactly what happened and how, can be critical to your claim.
• Employee fails to fill out accident report accurately, or accident report is not signed. Make sure your accident report is completely filled out and signed, and that all the details are accurate. If your employer asks you to fill out a report when you are feeling ill, or have been medicated due to your injuries, tell the employer you will fill out the paperwork when you are feeling better.
• Employee’s statements are inconsistent. Make sure your statements regarding your accident and subsequent injuries remain consistent, across the board. Any inconsistency, no matter how small, can be used as an excuse to deny your claim.
• Employee signs authorization allowing employer or insurer to obtain all medical records. If you are asked to sign an authorization which allows the insurer to obtain copies of your medical records and expenses, make sure it is a limited medical authorization which only allows access to medical bills and records directly related to your work injury. Allowing access to your past medical records could lead to the insurer claiming your current injury is related to a past medical condition rather than your current work-related injury.