How To Deal With (And Avoid) Workers’ Compensation Disputes
Dan Levenson November 24, 2015
You may think workers’ compensation disputes can’t happen when the whole point of having a policy is to protect yourself and your workers. Insurance companies aren’t completely infallible, though, when it comes to dealing with insurance matters. It all depends on where you obtain your insurance, of course, but you need some contingency plans at the ready if and when disputes occur.
Unfortunate as it is, workers’ compensation disputes are more likely than you think. Your employees may have certain situations after being injured on the job that they think aren’t adequately addressed by your workers’ comp policy.
In a more general sense, your employees may not think they’re getting the right type of benefits, the right amount, or even enough during a particular duration of time. They may even have a problem collecting any benefits at all after suffering painful injuries and being unable to work temporarily or permanently.
As a business owner, you’ll have to step in and deal with these disputes, because they can definitely have satisfactory resolutions. Take a look at more specific and complex disputes that could happen and what steps may need doing to get them resolved.
Lack of Tests from an Unqualified Doctor
After one of your employees gets injured, a quality workers’ comp policy works with a qualified doctor to diagnose your employee. Your employee may claim they didn’t receive a doctor with enough qualifications to properly diagnose the particular incurred injury.
Further, the employee may not have received the tests they needed to properly diagnose their injury. This only hurts your employee, because they aren’t fairly compensated for a possibly more serious injury than what the insurance thinks.
Lower Benefits Than an Employee Deserves
Sometimes the insurance company ends up paying your injured employee less than what they deserve based on wage miscalculation. This can simply be a mistake rather than a judgment, though it can lead to some severe situations for your employees.
All workers’ comp does calculations based on how much the employee gets paid. Your injured employee could lose hundreds or thousands of dollars in disability checks if the calculation went by a lower wage than what the person really earns.
These type of disputes usually get solved faster simply by calling the insurance company and letting them know they were in error.
Being Forced to Go Back to Work Without Recovery Time
When insurance refuses to believe an injury claim, it can lead to numerous severe circumstances. One of the worst is when insurance refuses to believe an injury and forces your employee to go back to work too early. If your employee knows they can’t work due to a serious physical injury, it could lead to life-threatening issues for them.
In turn, this could instigate major litigation against you. Disputes with ongoing litigation only leads to massive money losses on both sides where the lawyers ultimately win.
As acknowledged above, some disputes are easier to solve than others. In most cases, it may involve mediation. Many states offer this as a resolution process so it doesn’t have to get lawyers involved.
Hearings and appeals are always the next step if it’s an overly complex issue needing a final decision by the insurance company. State workers’ compensation boards usually take care of dispute hearings that work similarly to a court of law.
As for appeals, they frequently have time limits, just like the statute of limitations on legal cases. When you and your employees have a dispute, it’s best to work together if possible and try to resolve it as quickly to avoid further time-wasting delays.