Tips For Minimizing Your Risk Of Denial By The Insurance Company Delaware Workers’ Compensation Benefits
1. File your claim promptly.
Under the Delaware Workers’ Compensation laws you only have a certain amount of time in which to file a claim. This is called the “Statute of Limitations,” and here in Delaware, that time limit is two years. In order to get your claim filed, a “First Report of Injury” form needs to be filled out and sent to the Industrial Accident Board (IAB).
That being said, you really should notify your employer of your injury immediately when it happens. Any delay in notifying your employer could turn into a battle for you to prove that your injury is work-related down the road. Once your employer is notified, they should give you the contact information for their workers’ compensation insurance company. If they do not have Workers’ Compensation Insurance, or will not give you their insurance company name, then you should consult a Workers’ Compensation Attorney for advice on how to proceed.
If your employer has no workers’ compensation insurance coverage, you may still qualify for benefits. In this scenario, your employer may be forced to pay your benefits directly to you and your doctors, instead of the payments being made by the insurance company. If your employer refuses to provide the insurance company name to you, a skilled workers’ compensation attorney will be able to look up this information for you so that you can still file a claim with the insurance company, regardless of whether your employer cooperates.
Once you know the Workers’ Compensation Insurance Company, a claim should be made to them as promptly as possible. Be prepared to tell them the name of the company you work for, how you were injured, what your injuries are, your rate of pay and the name of the person that you reported your injury to as well as any eye witnesses to your injury. If at all possible, you should have legal representation for this. The insurance company representative will then give you a claim number, which you can then give to the doctors and hospitals that treat your injuries.
2. Make sure you are seeing a provider that is “certified” by the Industrial Accident Board.
Under Delaware Workers’ Compensation law, an injured worker can choose to see whomever they wish to treat their work-related injuries.
If this provider (and by provider, I mean doctor, nurse, physician assistant, physical therapist, chiropractor, etc.) is not a “Delaware Certified” Workers’ Compensation provider, the only way to guarantee that they will get paid for the treatment they render is to ask the insurance company to pre-approve it. If the insurance company does not pre-approve the treatment, the provider may try to collect the cost of treatment from you directly.
In order to protect injured workers, the Delaware Department of Labor has established a standard for “Certified Medical Providers” whereby a doctor, nurse, therapist, etc. can take a test and become certified. In becoming certified, the provider agrees to accept payment according to the Delaware Workers’ Compensation Fee Schedule. Conversely, the bills that the provider submits to the insurance carrier for treatment of your work-related injury are assumed to be reasonable, necessary and related
to your work injury, unless your employer can prove otherwise.
The bottom line is that everyone involved in your treatment, from the doctors to the therapists should be certified in order to make sure that you have as little chance as possible of having to pay the medical bills out of your own pocket. The Delaware Office of Workers’ Compensation compiles a list of certified providers and updates this list daily. The list can be found on their website at http://dia.delawareworks.com/workers-comp/hcps/provider-certification.php. I recommend checking this list before you see any providers for the first time, and then re-checking the list from time to time to make sure that their certification has not expired. If you are unable or unsure of how to do this, I encourage you to contact my office for assistance.
If you or your loved one is injured on the job, timely reporting the injury and making sure that the health professionals that care for you will help maximize your benefits and can reduce or eliminate any risk to you of having to pay for medical bills out of your own pocket. A consultation with a lawyer who specializes in this area will be able to give you insight as to whether your particular injury qualifies for Workers’ Compensation benefits, and whether the providers that are treating you are “certified.” All of the lawyers in my firm, including myself, offer consultations for work injuries. The consultations are free, and the insight into your claim could be invaluable to your future health and benefits.
Heather has been an attorney for over six years, and is currently practicing workers’ compensation and personal injury law at Kimmel, Carter, Roman & Peltz, P.A. with offices in Newark and Wilmington. Heather worked her way through law school as a paralegal in a personal injury firm. After passing the bar exam, she spent several years working as a defense attorney, representing local, regional and national companies. With the knowledge gained of the
inner-workings of these companies, she now represents injured workers and personal injury plaintiffs.
Heather is a graduate of Widener University School of Law, and the University of Nebraska- Lincoln. Prior to attending law school, she was licensed as a paramedic and spent time volunteering for her local ambulance corps. She is also active as a Mock Trial coach for Salesianum High School.
Heather is licensed to practice law in Delaware, Pennsylvania, New Jersey, and the U.S. Virgin Islands. For more information, or to schedule a free consultation, please call
(302) 565-6100 or e mail her directly at HLong@kcrlaw.com.
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