Why Would My Employer Deny My Claim?

Did the injury occur at work? The answer to why an employer would dispute a workers' comp claim is simple and boils down to a single five letter word: money. Like any other type of insurance product, employers pay premiums to provide workers' compensation benefits to workers (in most states, this is mandatory). Premium amounts are directly affected when injured workers file for benefits. Premium Costs Logically, the more workers' comp claims that are filed, the higher the costs for employers. Workers' comp insurance premiums increase when more workers than estimated file for claims, or when an employee has a particularly expensive claim (for instance, requiring back surgery). It is for this reason that employers and their insurance companies routinely use investigative agencies to monitor the daily activities of workers who have filed workers' compensation claims. Employer Bias Unfortunately, many employers don't believe that some injuries are serious or even valid, especially cumulative trauma injuries. They assume that a worker who files for workers' compensation benefits on the basis of carpal tunnel syndrome, another repetitive stress injury, or a lumbar back injury is not being completely truthful (or is "malingering," the industry term for feigning sickness or disability for financial gain). Employer bias is particularly strong against injuries involving inexplicable pain that cannot be wholly verified by medical examination, or even sufficiently verified by x-rays, other imaging, or nerve conduction studies. Does this mean that the injured worker who has constant back pain is malingering? Definitely not. Many medical conditions are difficult to objectively verify. Reasons for Denial of a Claim If your employer or its insurance company denies your claim, or any part of it, it should inform you in writing. Typical reasons given for denying a claim are: You didn't suffer a serious injury. Your injury didn't take place during work, or within the scope of employment. You don't need medical treatment for your injury. You don't need time off work for your injury. Fighting a Denial of Benefits If you receive a notice that your claim has been denied, call or write to your employer's workers' comp insurance carrier. If this doesn't solve the problem, hire a workers' comp lawyer and request a hearing with the state workers' comp board. The bottom line is this: employees who have become injured or sick as a result of their job should file for workers' comp to protect themselves, and if their claim is denied, they should fight the insurance company, with the help of a lawyer. Whether or not the employer believes that the worker is legitimately injured will turn out to be irrelevant, and the worker shouldn't worry about whether the employer holds the employee in contempt for filing a claim. It is the worker's right to have time off work and medical treatment paid for; the worker has given up the right to sue the employer in exchange for the workers' comp benefits and should not feel guilty about using them.

Why do I Need A Board Certified Workers Compensation Specialist?

I was injured at work in Connecticut. There was a witness. My contact at human resources assisted me with completing an incident report. I was on the clock and on the employer's premises when I was injured. Why won't the insurance company pay my benefits? Why am I waiting for medical treatment to be authorized? What appear to be the most frequently asked questions by injured workers immediately following a work injury become increasingly more difficult to answer as time moves on during the pendency of a claim. The Workers' Compensation Act has evolved a long way since its' inception in 1913. However, several themes remain true and stand the test of time. First, Connecticut's Workers' Compensation Act (the "Act") is meant to compensate the injured worker for their finanical loss and in particular - the weekly rate of pay that the employee lost as a result of the injury. If you are unable to perform any gainful employment as a result of the injury the Act protects against that loss. The inability to work must be substantiated by a physician. Once submitted, the employee gets paid her base compensation rate (a percentage of her average weekly rate) which happens to be non-taxable under the Act. Where is my check? Well, upon further review the insurance carrier's responsible adjuster is not volunarily paying until they hit a few items on their checklist. Wages verification from the employer. Obtain confirmation from the first call center as to loss of work capacity. Are there restrictions? Can the employer accomodate the injured employee's circumstances? Has the employee completed the proper forms to determine an average weekly wage or base compensation rate? Making matters more difficult, the injured worker's focus should be on getting better. The process of obtaining authorization for initial medical treatment from the responsible workers' compensation carrier can be an extremely difficult task especially for an individual and her family that did not expect to be thrust into difficult circumstances in an instant. Who is the carrier? Who is the adjuster? How difficult is it to get me a claim number? Why is this nurse calling me and why is he allowed to walk into my doctor's office with me? How come I have to go to this urgent call center so many times without getting a referral to a specialist physician? Another theme that stands the test of time is that the Act ensures the injured worker access to "reasonable and necessary" medical treatment. Again, this seems like an easy problem to solve. I'm hurt at work. Get me to a doctor. I have spent more time litigating an injured worker's right to proper care than I care to divulge. Why? It is costly. The process between physician office and responsible adjuster is cumbersome. The insurance carrier, much like the verifications made before making payment of lost earnings also needs to confirm several aspects of your medical picture before authorizing treatment. Has the injured worker signed the proper forms to obtain treatment? Was there a pre-existing injury or accident causing the need for treatment? Does the injured worker have private insurance to process the cost of medical treatment during our investigation? Has the doctor's office submitted the proper codes and documentation. Do you see the common theme here? Navigating your claim has become increasingly difficult given the delays involved from the onset with respect to payment of benefits and rendering of medical care. The cost of benefits and treatment to the carrier often drive the contest of any claim. Even in "accepted" claims, the carrier will often litigate matters of import throughout the course of the claim. Setting the tone early with the responsible workers' compensation carrier and claims adjuster when you have a serious work injury is important. Not every case necessitates the involvement of an attorney. However, it's extremely prudent to get the advice of one before the process gets out of hand.

Venue in Connecticut Workers Compensation

This is the Location of the First District Worker’s Compensation Commission in Hartford. There are 8 District offices around the state and we appear in all of them. Which office handles your claim is a function of the location you were injured. Feel free to call with any questions about case venue.

SI Joint Injuries. A Common Workplace Occurrence

Sacroiliac joint Injuries Overview Sacroiliac (SI) joint pain is felt in the low back and buttocks. The pain is caused by damage or injury to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. Physical therapy, stretching exercises, pain medication, and joint injections are used first to manage the symptoms. Surgery to fuse the joint and stop painful motion may be recommended. What is sacroiliac joint pain? The SI joints are located between the iliac bones and the sacrum, connecting the spine to the hips. The two joints provide support and stability, and play a major role in absorbing impact when walking and lifting. From the back, the SI joints are located below the waist where two dimples are visible. Sacroiliac joint anatomy Figure 1. The sacroiliac joints connect the base of the spine (sacrum) to the hip bones (ilium). Strong ligaments and muscles support the SI joints. There is a very small amount of motion in the joint for normal body flexibility. As we age our bones become arthritic and ligaments stiffen. When the cartilage wears down, the bones may rub together causing pain (Fig. 1). The SI joint is a synovial joint filled with fluid. This type of joint has free nerve endings that can cause chronic pain if the joint degenerates or does not move properly. Sacroiliac joint pain ranges from mild to severe depending on the extent and cause of injury. Acute SI joint pain occurs suddenly and usually heals within several days to weeks. Chronic SI joint pain persists for more than three months; it may be felt all the time or worsen with certain activities. Other terms for SI joint pain include: SI joint dysfunction, SI joint syndrome, SI joint strain and SI joint inflammation. What are the symptoms? The signs and symptoms of SI pain start in the lower back and buttock, and may radiate to the lower hip, groin or upper thigh. While the pain is usually one sided, it can occur on both sides. Patients may also experience numbness or tingling in the leg or a feeling of weakness in the leg. Symptoms may worsen with sitting, standing, sleeping, walking or climbing stairs. Often the SI joint is painful sitting or sleeping on the affected side. Some people have difficulty riding in a car or standing, sitting or walking too long. Pain can be worse with transitional movements (going from sit to stand), standing on one leg or climbing stairs. What are the causes? The SI joint can become painful when the ligaments become too loose or too tight. This can occur as the result of a fall, work injury, car accident, pregnancy and childbirth, or hip/spine surgery (laminectomy, lumbar fusion). Sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement may occur when one leg is longer or weaker than the other, or with arthritis in the hip or knee problems. Autoimmune diseases, such as ankylosingspondyloarthropathy, and biomechanical conditions, such as wearing a walking boot following foot/ankle surgery or non-supportive footwear, can lead to degenerative sacroiliitis. How is a diagnosis made? A medical exam will help determine whether the SI joint is the source of your pain. Evaluation includes a medical history and physical exam. Your physician will consider all the information you provided, including any history of injury, location of your pain, and problems standing or sleeping. There are specific tests to determine whether the SI joint is the source of pain. You may be asked to stand or move in different positions and point to where you feel pain. Your doctor may manipulate your joints or feel for tenderness over your SI joint. Imaging studies, such as X-ray, CT, or MRI, may be ordered to help in the diagnosis and to check for other spine and hip related problems. A diagnostic SI joint injection may be performed to confirm the cause of pain. The SI joint is injected with a local anesthetic and corticosteroid medication. The injection is given using X-ray fluoroscopy to ensure accurate needle placement in the SI joint. Your pain level is evaluated before and 20-30 minutes after injection, and monitored over the next week. Sacroiliac joint involvement is confirmed if your pain level decreases by more than 75%. If your pain level does not change after the injection, it is unlikely that the SI joint is the cause of your low back pain. What treatments are available? Nonsurgical treatments: Physical therapy, chiropractic manipulation, and stretching exercises help many patients. Some patients may require oral anti-inflammatory medications or topical patches, creams, salves or mechanical bracing. SI joint injection Figure 2. A needle is gently guided into the sacroiliac joint using x-ray fluoroscopy. An anesthetic and corticosteroid mixture (green) is injected into the inflamed joint. Joint injections: Steroids can reduce the swelling and inflammation of the nerves. Joint injections are a minimally invasive procedure that involves an injection of a corticosteroid and an analgesic-numbing agent into the painful joint (Fig. 2). While the results tend to be temporary, if the injections are helpful they can be repeated up to three times a year. Nerve ablations: Injections into joints or nerves are sometimes called “blocks.” Successful SI joint injections may indicate that you could benefit from radiofrequency ablation – a procedure that uses an electrical current to destroy the nerve fibers carrying pain signals in the joint. Surgery: If nonsurgical treatments and joint injections do not provide pain relief, your physician may recommend minimally invasive SI joint fusion surgery. Through a small incision, the surgeon places titanium (metal) implants and bone graft material to stabilize the joint and promote bone growth. The surgery takes about an hour. The patient may go home the same day or following day. For several weeks after surgery, the patient cannot bear full weight on the operated side and must use crutches for support. Sacroiliac joint fusion Figure 3. In a sacroiliac joint fusion, rod and/or screw devices are placed across the joint to stop painful motion. Recovery and prevention A positive attitude, regular activity, and a prompt return to work are all very important elements of recovery. If regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time. Prevention is key to avoiding recurrence: Proper lifting techniques Good posture during sitting, standing, moving, and sleeping Regular exercise with stretching /strengthening An ergonomic work area Good nutrition, healthy weight, lean body mass Stress management and relaxation techniques No smoking Our office is well versed in SI joint injuries and can help you find appropriate treatment and receive compensation where appropriate. Call us anytime with any questions we can answer.

Amazon Injuries in Connecticut

Amazon is one of the largest employers in the Connecticut As a global leader in the shopping and deliver logistics, Amazon employs a wide range of people in Connecticut from ooffice professionals, to drivers, to package handlers. Unfortunately, workplace injuries are a major issue at every company. If you are an Amazon employee who was hurt while on the job, whether you were working on the road, on the plant floor or in the office, you need to know how to protect your legal rights At The Law Offices of James F Aspell, P.C. Hartford workers’ compensation lawyers are proud to be committed advocates for employees throughout the state of Connecticut. Here, we highlight the five most important steps that injured Amazon workers need to take after a job-related accident. Report Your Injury & File Your Claim Within the Deadline Under Connecticut workers’ compensation regulations, both employers and employees have certain basic legal obligations. Injured workers must report their accident to their employer (usually your supervisor). Reporting your injury is also the first step in filing a worker’s compensation claim. Once you report your injury, your supervisor (or perhaps a human resources worker or another representative) may provide you with a worker’s compensation claim form. If one isn’t provided, however, simply ask. Fill out the form and return it to your supervisor (or whomever your supervisor directs you to). This will begin your claim. However, you will also need to formally file a claim with the Connecticut Workers Compensation Commission through proper service of a Form 30C. You Should Seek Immediate Medical Attention It is critical that you seek medical care and let your provider know you were injured on the job. First and foremost, injured workers should see a doctor for their own health and well-being. Second, a medical provider should complete a report indicating you were injured on the job and what your restrictions are. Your claim will not be allowed without medical support. A medical provider will help document your injuries and notify Amazon about what benefits are appropriate for you. This could save you time and trouble if you do it as soon as you reasonably can. For many benefits, a medical provider’s opinion and certification will be required before appropriate benefits will be paid, which is another important reason to begin treatment. File your Claim Within the Deadline All your paperwork must be properly completed and submitted before the relevant deadline. For job-related injuries, Amazon workers generally have one year to file their claim. For occupational diseases, Amazon workers in Connecticut generally have two years from the date a physician tells them in writing that they have an occupational disease and that they may file a claim for it. If you do not file within the appropriate deadline, your claim will be forever barred. The sooner you file your workers’ compensation claim, the better your chances for a successful result. You Have the Right to Protest a Claim Denial Ideally, your workers’ compensation benefits will be paid in full soon after you submit your initial workers’ compensation claim. Unfortunately, that is not how the system always works. If your Amazon work injury claim is denied, (You receive a Form 43) you have the right to request a hearing with the Commissioner. You Should Speak to a Workers’ Compensation Attorney Full and fair workers’ compensation benefits can sometimes be difficult to recover. If you were hurt on the job while working at Amazon, and your work injury claim was denied, it is crucial that you seek professional legal guidance. Your Hartford, Connecticut work injury attorney will be able to conduct a detailed review of your claim to determine what action must be taken to protect your rights. You may still be eligible to recover workers’ compensation benefits. At The Law Offices of James F. Aspell, P.C., our legal team is committed to fighting for the rights and interests of injured workers. If you or your family member was injured while working at an Amazon facility in Connecticut, we can help. For a free consultation, whether your claim has been allowed or denied, please contact our law firm today. We have offices in Farmington and represent Amazon employees throughout Connecticut.

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Connecticut Workplace Assault

The news yesterday told a story of a Connecticut Transit bus driver who was attacked by an irate passenger while simply trying to complete his route. Sadly, Workplace assaults are for more common than you might think. Every day, transit workers, nurses, teachers and paraprofessionals, as well as social workers and convenience store attendants sustain injury when they are attacked while just doing their job. The Connecticut Workers Compensation system stands ready to help these folks with wage replacement, medical treatment and a host of other benefits. The procedure for filing a claim is no different that instituting any other Connecticut workers compensation claim. That is, the injured worker, or their attorney, properly serves a Form 30C on the employer and the District office having jurisdiction other the location where the injury occurred. From there, the process proceeds in due course. Please be aware an injured worker in Connecticut typically has one year from the date of injury to bring their claim.