Receiving benefits through workers’ compensation should be as simple as proving that you were injured or rendered ill as a direct result of a workplace accident or dangerous working conditions. In practice, these claims are often complicated and time-consuming because of how hard workers’ compensation insurance providers often fight to protect their own financial interests at the expense of claimants.
The most important thing to remember when meeting with insurance companies during a Santa Ana workers’ compensation claim is that the insurance company is not on your side. You need to keep that in mind as you approach every interaction with them. Of course, this can be tricky to manage alone. To protect your best interests, it is important to have help from an experienced workers’ compensation attorney whenever you speak with an insurance company regarding your claim.
Once an employee reports a work-related injury to their employer and that employer sends the appropriate claim paperwork to their workers’ compensation insurance provider, the insurance company will first conduct an investigation into whether the claim has merit. This means the claims adjuster who is responsible for handling the claim in question will assess whether the claimant’s injury is actually covered by workers’ compensation. For example, they may review employee logs and surveillance camera footage to establish that the injury happened at work and check to ensure the claimant is seeking necessary medical care from approved physicians.
If the claims adjuster decides to accept the workers’ compensation claim based on this initial investigation, they will start a second investigation to determine what disability benefits the claimant needs as a result of their injuries. This stage of the process typically involves checking records kept by the claimant’s treating physicians and testimony from other medical experts, some of whom may have a consistent working relationship with a particular insurance provider. If you have a meeting with insurance company representatives during this process, a Santa Ana attorney could help you with the documentation of your workers’ compensation claim.
At various points during these initial investigations, as well as during appeals against claim denials, a claims adjuster may contact a claimant directly to ask questions about their accident, their injuries, and the effects these injuries have had on their life. It is crucial to be truthful when answering questions about your claim during any talks with a workers’ compensation insurance representative in Santa Ana; however, it is also important to avoid offering information that is not explicitly requested. For example, you should avoid speculating about the long-term effects of your injury or accepting any personal fault for the incident—implicitly or otherwise.
The same approach should be taken with private settlement talks at the conclusion of a workers’ compensation claim. This is the point where the insurance company will be seeking to end the case quickly and with as little financial liability placed on themselves as possible. Representation from experienced legal counsel can be vital toward ensuring that insurance representatives are fair during these talks and that a claimant can clearly communicate their needs.
Even if you know that you have strong evidence for a workers’ compensation claim, proving that fact to your employer’s workers’ compensation insurance provider may be far from simple. Fortunately, individual claimants can do a lot to strengthen their own cases by being conscious of their own best interests while meeting with insurance companies during a Santa Ana workers’ compensation claim.
If you have further questions about how to proactively handle insurance negotiations in a workers’ compensation case, a knowledgeable attorney could help answer them during a confidential consultation. Call us today to schedule your consultation and receive the help you may need.
