In many ways, the law is in the wounded workers’ favor. However, due to the (mis)management of their claims by the Department of Labor & Industries and self-insured businesses, most wounded workers would not be aware of this. The most frequent errors we notice in workers’ compensation claims are shown below. If you think your Washington State workers’ compensation claim has one or more of these errors, call Seattle Workers Compensation Attorney.
Irregular decision-making on claims will be done by the Department or self-insured employer only based on an “independent medical evaluation” (IME).
The claim is often denied because the Department’s or self-insured employer’s IME found that an industrial injury or occupational disease did not bring on a medical condition.
In response to an IME, attorneys can frequently get claim rejection orders reversed by obtaining the attending physician’s opinion. According to the legislation, a doctor must submit an application for workers’ compensation payments if they feel a patient has suffered an injury brought on by a sudden and concrete event at work or by unique conditions of employment. Because the legislation stipulates that the attending physician’s view must be given special regard over that of a one-time examiner, this is frequently sufficient evidence to prove that the claim must be allowed.
The claim manager or doctor fails to consider the injured worker’s pre-existing problems.
Another typical scenario is when a person’s time loss compensation has expired or is soon to expire, but they are still unable to work. Too frequently, the Department or a self-insured company ends time off due to pre-existing conditions rather than an industrial injury or occupational disease, in the view of the IME physician. According to the legislation, when determining a worker’s capacity for work, we must take into account all of their physical and mental limitations.
Assuming that a worker’s inability to work must be due only or even primarily to a work-related illness or injury.
The denial of medical care due to the possible occupational damage caused by a factor other than employment is another frequent justification. Because they may be attributed to injuries or illnesses brought on by aging, wounded workers over the age of 35 experience this frequently. A condition may have one or more proximal causes. The law only requires that workplace damage be an immediate cause of the alleged ailment for which benefits are requested; it does not require that it be the principal or substantial cause.