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Stephen Bulzomi John Christensen Jeremy Johnston James McCormick Gemma Zanowski

When Workers’ Comp Doesn’t Cover Everything

Now that we know how to report a workplace accident, it’s time to discuss workers’ compensation.  As we previously noted, workers’ compensation will typically entitle you to weekly benefits of two-thirds of your gross weekly wage, after you have been unable to work for seven days and filed the appropriate paperwork.  Unfortunately, even this is not guaranteed and whatever fraction you receive of your usual wages may not be enough to support you.  It may not even cover all or any of your medical expenses in some cases.

Know Your Options

For this reason, is it important to have a clear understanding of what your other options are.  Start by finding out what workers’ compensation you’re entitled to at your workplace by contacting your office’s workers’ compensation insurer right away.  If they tell you that you are entitled to benefits you have not received, request an LDOL-WC-1008 “Claim for Compensation” form to fill out and contact a lawyer to discuss your options right away.

If your workers’ compensation claim has been completely denied by the insurance company, you can fill out an “Application for Adjudication of Claim” form to try and reverse the decision.  Your chances of succeeding with this will be greatly increased if you’re able to hire a Tacoma personal injury attorney to assist with the process.

Common reasons cited for application denials can include:
– blank dates on the Workers’ Compensation Claim Form (remember that in the case of continuous trauma injuries, you may leave a date range rather than a single date);
– injuries to areas of the body that have previously been injured prior to employment;
– injuries that occur during the work commute;
– injuries without substantial medical evidence;
– injuries without witnesses;
– injuries that seem to have occurred over the weekend; or
– employers that dispute the injury’s occurrence or are otherwise uncooperative.

It is particularly often that claims are denied due to uncooperative workplaces or injuries that have been deemed to not have enough substantiated medical evidence.  If your claim has been denied for these or any other reasons, your best hope will always be to contact a personal injury attorney right away.

If your employer denies your disability status or you believe that your workplace is unsafe, one option at your disposal is to ask OSHA to inspect your workplace.  You are entitled to records of past work-related injuries and illnesses as well as copies of any and all test results regarding possible workplace hazards–all of which can be particularly useful evidence should you have to undertake legal action.  A personal injury attorney will always be the best resource in guiding you through these investigation processes.

It’s advisable to reach out to a Tacoma personal injury attorney if your determination is delayed–which is more common than an outright denial. The delay letter you receive will inform you of the following:

– any outstanding information the adjuster will need to determine the status of your claim;
– the date the decision will be made about the claim (which will be within 90 days); and
– the amount of monies you are entitled to in medical coverage over the course of the investigation itself.

These monies can be up to $10,000.00, but if the claim is denied then you will lose access to them after the decision.

It’s also possible that your workplace may not even offer workers’ compensation.  Should you find out that this is the case, or that your workers’ compensation will not cover any or all costs related to your accident, do not fret: there still may be other options for you.  You may be eligible for disability funds through Social Security or other sources.

In order to receive Social Security disability funds, you must have been injured for over six months and begun the application process for disability benefits through Social Security as soon as possible after the accident.  After the first month of your disability, the determination process will begin.  If it is determined that you are eligible, your benefits will begin during the sixth month of the disability.  Supplemental Security Income (SSI) is another possible source of disability funds from the Social Security Administration.

To find out whether either of these sources may apply to your circumstances, visit the Social Security Administration’s disability website here.

Contact us to speak with a Tacoma Personal Injury Attorney right away.