Workers’ Compensation Attorney Needed Even In Accepted Claims

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Workers’ Compensation Attorney Needed Even In Accepted Claims

So you have filed your claim and you are relieved to receive a notice of acceptance. The insurer may have accepted a strain or sprain or a contusion.  Workers’ Comp attorneys call this an “Under-accepted claim”.  This initial notice of acceptance often times lulls an injured worker into believing that the insurance company is taking responsibility for their injury and will take care of them until they are ready to return to work.

Often times this is not the case.  While the injured worker believes they are now in the clear with an accepted claim the insurer is just getting started on shutting the claim down with little or no compensation.  They will be obtaining any and all potentially relevant medical records. They may be speaking to or writing to your doctor about your prior medical history without your knowledge.  They may be setting up an appointment for a mandatory “Independent Medical Exam” to aid closure or denial of the claim.  Again, this can all be happening in the background without any notice to you until the denial or closure is issued.


What many injured workers fail to understand is that the insurance company may authorize medical treatment for quite some time without accepting full responsibility for a work injury.  All the while they are building their case and creating a plan to shut down your claim.  If your claim is only accepted for a strain or sprain then your claim could easily be closed or denied with just a letter or two from the insurer to your doctor.  Even if your doctor supports you and wants to help they may be completely unable to do anything if your claim is under accepted.

There are two main ways that an insurer will shut down an accepted claim.  First they may push for a closure without an award for permanent impairment.  The closure will affect your right to compensation and will limit your rights to continuing medical care. The other way a claim can be quickly shut down is with a “combined condition denial”.  This kind of denial is used when a pre-existing medical condition is diagnosed and the insurer takes the position that the current need for medical treatment is due to the pre-existing condition and not the work injury.


One less common way for a claim to end is with what is called a “back-up denial”.  The insurer can deny the claim after acceptance if they can prove that an injured worker obtained benefits through fraud or misrepresentation.  If a back-up denial is issued, the injured worker will become responsible for the bills that the insurer has paid for medical services on the claim.  In my experience this is very infrequently used and claim closure and combined condition denials are far more frequently used by the insurer to end a claim.

As experienced workers’ compensation attorneys we can see these problems coming and do something about it before it is too late.  We may be able to speak with your doctor to build support for the case.  We will obtain the letters and correspondence between your doctor and the insurance company.  If your claim is under-accepted we will do a thorough review of your medical records to determine if any other diagnoses or conditions should be added to your claim.  Call us for a free consultation and we can discuss the under-acceptance issue with you and how it might affect your claim.  The earlier you know where your claim stands the sooner you can make informed choices and decisions regarding your rights in workers’ compensation.


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The above information is NOT a substitute for legal advice and should not be interpreted as the dissemination of legal advice. It is only meant as general guidance on various issues which may be applicable to your situation. It is critical that you
consult with an experienced attorney before taking any legal action or have specific questions addressing your particular case answered.


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