If only I had a nickel for every time I heard this from an injured worker dealing with the workers’ compensation claim system!
I get so many calls from folks who are frustrated that they are waiting for approval for medications, doctor’s visits, diagnostic testing, or surgery ,waiting for a hearing, the list goes on and on.
First of all, let me just tell you flat out that filing a workers’ compensation claim is an imperfect and SLOW process. I’m not trying to scare anyone but the truth needs to be told. The insurance company has the right to review your whole medical history, as well as any records relating to your current injury before making a determination as to whether the claim, as a whole, is approved or denied. The process of document gathering and review is repeated any time there is a request for new treatment or when there is a change in the injured workers’ status (like being taken off of work or returning to work). And, as with everything else, this process takes time.
The other thing injured workers are surprised to learn is that when the insurance company requests a second opinion, they will not approve any new treatment until the second opinion is performed and the adjuster is able to review the independent doctor’s evaluation. Depending on scheduling and the amount of time it takes the doctor’s office to forward their evaluation on to the adjuster and the time it takes the adjuster to review the report and make a determination, this process can sometimes take several weeks.
From what I have seen, adjusters are usually working on several different cases at once, so, they are dealing with multiple injured workers, doctors, case managers, and, sometimes, attorneys. Please understand, I am NOT making excuses for any adjuster or any insurance company that delays an injured worker’s treatment. In fact, nothing irks me more than when my clients have to wait for something their doctor has clearly indicated they need. I am simply trying to help my clients and all the injured workers out there have a better understanding of the process that goes on in the background.
There are also other reasons the process can be delayed. For example, if you haven’t filed a Claim for Benefits with the Virginia Workers’ Compensation Commission, the adjusters know that they have a lot more freedom in how they manage your claim because they don’t have the Commission overlooking the matter. Also, you need to know that when you file the Claim for Benefits form, there is also a waiting period associated with this to allow the insurance company time to gather information and respond to the Commission as to whether they will accept or deny your claim. This is why I typically tell injured workers to get this Claim for Benefits filed sooner, rather than later, because if we need to go to the Commission for a hearing on something, the Claim for Benefits must be filed with the Commission and the time for the insurance carrier to respond must have lapsed before the Commission will address any issues and set up a hearing.
There are several reasons a workers’ compensation claim takes time and, most often, the insurance company is not eager to explain to you what is going on or the reason for the hold up. If you are unsure about what is going on with your claim or why things seem to be taking so long, you may need to speak to an attorney about your specific situation to shed some light on the situation.
If you have questions about the Virginia workers’ compensation process or if you would like more information on the Virginia workers’ compensation system, order my book, “The Ultimate Guide to Workers’ Compensation in Virginia”, or call our office today (804) 755-7755.