Claim Investigation Process: I hurt myself at work. You want to know what!?

Information the insurance company may demand as part of its claim investigation process. Know what to expect after a work injury.

Most employers have established procedures when an employee is hurt on-the-job. This usually includes a written accident report and an employee statement.

Michigan law gives the employer choice of doctor for the first 28 days. Injured employees are typically sent to an industrial or work clinic. Wage loss benefits should begin after seven days of disability.

Employees are typically contacted directly by the insurance company or third-party administrator. Some claims are paid right away while others must be investigated.

Claim investigation process

The insurance company may ask for a description of how the injury occurred. Information about specific dates, times, and witnesses will be requested. Some insurance companies will want to make a recorded statement.

Type of disability that is being claimed. What part of the body is affected. Is the employee asking for wage loss or just medical treatment.

Names, telephone numbers, and addresses of all doctors. This includes hospitals and other medical facilities. Medical records might need to be obtained before a decision can be made.

Does the employee have any pre-existing conditions. The insurance company will want to know about past injuries and medical treatment. Expect your medical history to become an open book.

Has the employee returned to work for another employer. Are other jobs available that an employee could perform even with his or her injury.

Workers comp denied

We have seen insurance companies go way beyond what is actually required to make a claim decision. This is usually an excuse to deny benefits.

We suggest contacting an experienced workers comp lawyer immediately if this occurs. You should not feel like a criminal just because you made an insurance claim.

Call (855) 221-2667 for a free telephone consultation. We can help you avoid minor problems before the insurance company finds a reason to dispute your claim.

Alex Berman is the founder of Michigan Workers Comp Lawyers. He’s been representing injured and disabled workers exclusively for more than 35 years. Alex has helped countless people obtain workers comp benefits and never charges a fee to review a case.

Related information:

Video: Red flags in Michigan workmans comp

Photo courtesy of Creative Commons, by Generationbass.com.

07/01/2013
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