When Your Workers Compensation Claim Is Under Investigation

Often times, especially at the beginning stages of a claim, the workers’ compensation claim is under investigation and the injured worker is waiting to hear from the insurance company as to whether or not their claim is approved or denied. This situation can be exasperating when the insurance adjuster does not give the injured worker a definitive answer but instead says that their claim is being “investigated.” This, therefore, also means everything is on hold-lost wages, approval of the medical treatment, etc.  Injured workers need to know what it means when their workers’ compensation claim is under investigation:

The insurance company has a “reasonable” amount of time to investigate the claim. The adjuster may look into the injured worker’s medical history (requesting copies of all their medical records), look at the accident reports, gather prior wage information, and/or talk to their employer and any witnesses before they make a determination as to whether or not to deny or accept the claim. Usually, while a claim is under investigation, the insurance adjuster will not authorize any (or very limited) medical care for the injured worker until a decision has been made. Definitely, they will not pay for lost wages.

So what can an injured worker do during this time? Here are a few tips to follow during this difficult time:

1) Call and/or email the insurance adjuster and follow up on the progress of their claim regularly; gather documents quickly for them. I know this may seem like you are helping the insurance adjuster do their job, but they are dealing with several other cases so I always recommend that folks be proactive.

2) File a Claim Form and formally request benefits (especially medical care) through the Virginia Workers Compensation Commission as well. (https://workcomp.virginia.gov/forms/claim-form)

3) Remain in contact with their employer and doctor’s office (if they have one). Your employer needs to know about any changes the doctor has made to your work status.

4) Document EVERYTHING and save copies of anything they send to their employer, the workers’ compensation insurance company, or the Virginia Workers Compensation Commission.

5) Get educated in the workers compensation process. Order a copy of my book, The Ultimate Guide to Workers’ Compensation in Virginia and learn what is going on in the background.  Be able to identify all the different parties and their roles in a workers’ compensation claim and know what the rights and responsibilities of an injured worker are.

6) Cooperate with any light-duty work your employer offer’s you. If you are not able to do the work the employer gives you, you need to contact the doctor right away!

7) Set up your WebFile account. WebFile is a portal through the Virginia Workers Compensation Commission’s website. This is basically an online repository of all of your documents and claim information. This allows you faster access to notices and letters from the Commission and insurance company, rather than waiting for the mail. You can set up your WebFile account by going here (https://workcomp.virginia.gov/webfile).

Once there is a decision from the workers’ compensation insurance adjuster, if the above tips have been followed, you should be in a better position to pursue their claim whether it is approved or denied.

If your claim is denied, find out why!

You may get an answer like:

• Non-compensable Injury
• Unexplained Injury
• Pre-existing Injury
• No Supporting Medical Documentation
• Failure to Report

For further explanations on these go here https://www.injuredworkerslawfirm.com/blogs/5-reasons-claim-denied/

Then contact a lawyer immediately!

The Injured Workers Law Firm is focused on serving clients with workers’ compensation claims throughout Virginia. For answers to your questions about benefits download our book, The Ultimate Guide to Workers’ Compensation in Virginia or call our office today (804) 755-7755. The Injured Workers Law Firm, serving Fredericksburg, Virginia Beach, Manassas, Charlottesville, Fairfax, Hampton Roads, and all of Virginia.