Interviewer: When you meet with a client for the first time, what are some of the things that you are going to ask that client to bring when it comes to workers comp?
Kevin Roach: I always ask my clients to bring any documentation they have that they feel may be related. If the claim has already been filed, they have an injury number from the Missouri Division of Workers Compensation. I ask for any correspondence from an insurance company and/or employer, as well as any medical records they have. They may have copies of x-rays or MRIs. I also ask for the names and numbers of any doctors you may have treated with.
Witness Statements from Co-Workers Can Be Helpful If the Claim Is Disputed
If there's a dispute as to whether or not the injury happened at work, we like to get any witnesses that may have seen the injury or accident, or anybody that may have knowledge of it shortly after it happened. Anything that you can bring in related to your claim is always helpful.
Why Are Some Workers Compensation Claims Denied?
Interviewer: What are some ways that people can get rejected from receiving workers comp?
Some Claims Are Illegitimately Denied and in Others, the Injured Worker Is Released from Medical Care Too Soon
Kevin Roach: I frequently see people whose claims were initially denied; and majority of the time, there’s no legitimate reason. Unfortunately, the system is Missouri is set up to where the insurance company gets to pick the doctors. A lot of times these doctors, they are really dependent on receiving all this business from the insurance companies so they want to keep the insurance companies happy.
This is especially common when employees are unrepresented. Dr. Smith might treat the injured worker, take him off work for a couple of days, and then out of the blue release the employee back to full duties. I see a lot of employees come in to my office with unresolved injury complaints that were released far too early and by this point the employee’s injuries have only worsened, ultimately making a bigger mess for both the employee and the employer.
Some Doctors Chosen by the Insurance Company May Not Attribute the Injury to a Duty Performed at Work
A doctor may say such scenarios as: "Well, this isn't a compensable claim. Maybe you have carpal tunnel" or "This is because you're overweight, or because you have diabetes. That's what caused your carpal tunnel." They will deny your claim for any reason they can find; ultimately stating that your work was not the prevailing factor.
Lack of Notice Can Result in a Claim Being Denied
In Missouri, that's what they have to show. They have to show that your work injury was the prevailing factor. That means it wasn't caused by something else that you did outside of work. I see frequently in occupational disease claims where the claim is denied and there's really not a legitimate reason for it. Another reason they are denied is the lack of notice. Maybe several months went by before they notified their employer of their injury so they are denied as well.