Reasons for delays in workers’ compensation cases and what you can do about it
Don’t hate the player, hate the game.
Former Florida Gator and NFL player, Tim Tebow, has stolen hearts as a football player for years now. Tebow recently decided to leave football and the SEC Network to play baseball. As he signs with the New York Mets, we are reminded that we don’t hate Tebow, we just hate the game he has chosen. (Not really, but please bear with us on this. We do like baseball.)
The same can be said for workers’ compensation. Don’t hate your attorney, hate the system.
When the goal of a workers’ compensation claim is to receive benefits to provide for recovery of an injury, the light at the end of the litigation tunnel seems distant without incurring any delays. Filing a workers’ compensation claim can already seem like a minefield of unknowable traps and obstacles lying in wait without accounting for the likelihood that your case’s end could be pushed back again and again.
When medical bills are piling up, the financial stress only adds to the pain of the injury. If it feels like your workers’ compensation claim is taking longer than you hoped, chances are you’re right. These claims can take a long time. The specifics of your workers’ comp claim and whether your claim is approved or denied can determine the length of time that passes before you receive benefits.
That is typically not your attorney’s fault. More than likely, your attorney is doing everything they can to get your claim resolved or before a judge.
Unfortunately, the system by which the case moves is time-consuming and tedious.
Rather than leaving more questions unanswered, this article’s aim is to shed some light on what goes on behind the curtain of your workers’ comp claim.
How to start a workers’ comp claim
Written notice of your injury to your employer must be given within 90 days of the accident for the injury to be compensable, though reporting the injury within 5 days is recommended. After this, the statute of limitations allows you 2 years to file a claim for workers’ compensation benefits.
In turn, your employer will notify its insurance provider of the claim for benefits in order to determine the compensability of the injury. This is the starting point of using delay as a tactic against the employee during the compensation process.
How insurance companies delay the workers’ comp process
It’s imperative to keep in mind that insurance companies, like any other corporation, operate for the purpose of turning a profit. While insurance firms may market themselves as for the people or for the employee’s benefit, the financial bottom line is still a driving force of its operation.
This leads to insurance adjusters employing tricks to cause undue delays when responding to claims. For example, an adjuster for the insurance provider may ask for an employee to provide information to the insurance firm that is not needed but takes time to produce. Once the information is provided, the adjuster may take longer than necessary to respond to emails or communications from the employee, causing further delay.
How does delaying a claim benefit the insurer?
The purpose of the delay is twofold. On the one hand, it prolongs the time until the insurance provider must pay out the benefits to the claimant, and on the other, it weakens the position of the employee, creating a dire need for benefits so that the employee is willing to accept a lower settlement offer.
Insurance companies maintain funds in interest-accruing accounts. The longer a larger sum is left in the account, the greater the return on the principal. This creates the incentive for insurance companies to delay paying out large lump sum benefits.
How does delaying a claim hurt the injured worker?
The delay in a return on the claim, in turn, creates a struggling financial situation for the injured employee, who cannot return to work yet has medical bills stacking up that must be paid. When money is sorely needed, claims delayed by the insurance provider can often result in the employee accepting a lower settlement without legal representation just to avoid accumulating debt.
An experienced workers’ compensation attorney can help prevent this scenario. Although the workers’ compensation filing process will take time, contacting an attorney sooner can help expedite the process and ensure you start receiving benefits as quickly as possible.
Real-life workers’ comp delay tactics experienced by one of our clients
On September 26, 2014, a woman was injured at work. She was performing her normal job duties when she was run over by a golf cart being operated by a coworker. The accident was witnessed by the coworker, and the company owner found out about the accident just a few minutes after it happened.
The woman injured her arm, shoulder and back. She required same-day emergency surgery on her broken arm, which included hardware being inserted into the arm.
So, the employer paid for the surgery and subsequent medical treatment, right?
No.
But the employer paid temporary total disability (TTD) benefits when their employee could not work, right?
No.
Despite being a witnessed accident and having workers’ compensation coverage to pay for these exact incidents, the employer did not do what they were supposed to do.
So, what options does an injured worker have if their employer refuses to move forward with their workers’ comp claim?
The injured woman hired our firm about 2 months after the accident because her medical bills were not being paid by her employer, despite the owner’s promises to do so.
Spoiler alert for injured workers: If your employer promises to pay your medical bills, it’s time to call a lawyer; it is probably not going to happen. Our client incurred more than $105,000 in medical bills.
Numerous letters and e-mails were sent to the workers’ compensation carrier for the employer. They never responded to them. The same went for the messages we left for the insurance adjuster.
As a result, we filed suit against the employer in January 2015. That was the only way to get the insurance carrier’s attention to do the right thing for our client.
About 10 days before we were scheduled to try the case and on the eve of deposing the employer’s corporate representative, the employer agreed to accept the claim as compensable and pay benefits pursuant to the Alabama Workers’ Compensation Act.
You would think the employer had a good reason for not providing benefits. During the course of discovery, we learned there really was no good defense to the workers’ compensation claim.
Our client waited almost an entire calendar year for the employer to do the right thing. As a result, our client’s claim is compensable pursuant to the consent order signed by the court.
What does this mean for our client?
The $105,000 worth of medical bills were paid by the employer. Our client was paid weekly temporary total disability (TTD) benefits. The employer provided her with a physician and paid for her medical bills and temporary total disability benefits going forward.
Looking back, had the workers’ compensation carrier responded to our firm and performed an investigation by interviewing our client, the delay and need for litigation could have been avoided.
However, the delay benefited the employer and insurance company, and not my client. Each passing day meant the insurance company held onto its money by not having to pay medical bills or indemnity benefits.
Unfortunately, the Alabama Workers’ Compensation Act does not have a lot of teeth in it, so the employer and its workers’ compensation carrier will not be punished for their decision to act this way.
Ultimately, we were very pleased with the benefits we were able to get for our client, and she was happy with the results. It’s a shame she had to wait so long and deal with the mounting medical bills and related anxiety that came with having a lawsuit.
Our client benefited from hiring an experienced workers’ compensation attorney early in the process. Not involving an attorney early can lead to decisions that can cause further harm to the injured worker.
Employers will continue to conduct themselves similarly to how this employer acted because the Alabama Workers’ Compensation Act does not deter such behavior. We will continue to do all that we can to get our clients the benefits they’re entitled to and look forward to the challenge.
How a workers’ comp claim moves through the legal system
After you hire a workers’ compensation attorney, they’re able to pursue your claim with the insurance adjuster on your behalf or file a lawsuit with the Circuit Court (or both). Once the complaint is filed, your employer has 30 days to file an answer to the complaint. After that, the process goes as follows.
Discovery period
A hearing is usually set on the matter. During the interim, your attorney will request discovery (documents related to your claim) from the opposing counsel. Opposing counsel has 30 days to respond to the discovery request and send any documents related to the claim.
Deposition
Your employer also has a right to conduct a deposition, which involves a question-and-answer session under oath. Since attorneys have fairly busy schedules, the deposition could be when your first hearing is scheduled, which means the hearing will be reset or continued.
Medical record request
Typically after a deposition, your employer may request medical records from any doctors you may have seen about your injury. They can also request records from your employer about any benefits you’ve received. These records take time to receive, usually 30 days at least.
Reaching maximum medical improvement
Another factor in this is the timing of when you reach maximum medical improvement. That is a term used in the workers’ compensation claims for when the authorized treating physician is of the professional opinion that the injured patient has reached the end of their healing process.
At this time, the doctor will usually assign a permanent impairment rating and determine if you’re able to return to work with restrictions. These things are needed to help shape the value of the claim.
Vocational evaluations and depositions
But even after maximum medical improvement is reached, many things have to be done to get the case ready for trial, including vocational evaluations and depositions of doctors and vocational experts. These things add even more time to the process.
Contact an Alabama workers’ compensation attorney
The financial strain caused by claims denied or delayed by employers or workers’ comp insurers can be overwhelming for injured employees, making it crucial to seek legal representation.
While the workers’ comp claim process is time-consuming and often frustrating, there is a light at the end of the tunnel. When your claim is finally heard, you have a chance of receiving the benefits you need. In some cases, the claim may be resolved before getting to a judge or without going through all of the steps, in which case your claim can move a lot faster.
At the Nomberg Law Firm, our attorneys work diligently to move your case along as quickly as possible. We work with our clients to make sure they’re informed during each step of the process. If you’ve been injured on the job and have a workers’ compensation claim you need to resolve, contact us to ensure your rights are protected. We can help you recover maximum compensation for your claim.
Bernard D. Nomberg has practiced law in Alabama for more than 20 years. Bernard has earned an AV rating from Martindale-Hubbell’s peer-review rating. He has been selected as a Super Lawyer by Super Lawyers Magazine as well as a Top Rated Attorney by B-Metro Magazine.