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The Role of the Employer’s Claims Advocate in Your Workers’ Comp Claim

A workers’ compensation claims advocate is a professional who specializes in helping employers manage their relationships with their workers’ comp insurance providers. Their most important role is to help the employer manage claims. For many employers, developing in-house expertise on claims processing is difficult or impractical, so they hire outside firms, often an insurance brokerage, to provide claims advocacy services. For the injured worker, a claims advocate can be a good resource and a significant help in the event that a claim is denied. At the same time, however, the employee needs to understand that the claims advocate’s job is to represent the employer, not the employee. A claims advocate works with his or her clients to help them manage the costs of their workers’ compensation program. The idea behind the role is to help employers avoid expensive litigation arising from denied or mishandled insurance claims. An advocate may provide a wide range of services, from training employees on risk management to helping resolve conflicts with insurers. A claims advocate typically has an insider’s perspective on how insurers operate, and can sometimes resolve issues in a way that avoids more costly forms of intervention. Employers often work with claims advocates as part of a broader investment in the welfare of their employees. As such, a claims advocate’s role is partly to help ensure that an injured employee gets the coverage they need. Employees can benefit from an advocate’s assistance in a number of distinct ways:
  • Ensuring that a claim satisfies legal and technical requirements.
  • Mediating between the injured employee, the employer, and the insurer to resolve disagreements.
  • Assisting the employer and employee to find solutions in the event that workers’ compensation won’t cover an injury.
On balance, services like these are of great benefit to an employee. But the employee always needs to remember that the advocate’s obligation is to the employer, not the employee. The advocate is there to help the employer save money by, among other things, reducing the risk of litigation. This motivation can result in a conflict of interest that may discourage the employee from pursuing the course that is in the employee’s best interest. Working with an experienced workers’ compensation law firm is a good way for an injured employee to ensure that the claims process is handled with the employee’s interests in mind. The law firm of Greenman Goldberg Raby Martinez has represented clients in workers’ compensation cases for over 45 years. For a free attorney consultation about your case call us at 702-388-4476 or through our contacts page.

When Must a Work-Related Injury Be Reported?

When Must a Work-Related Injury Be Reported?
People who get injured at work sometimes feel that they shouldn’t say anything about it. Perhaps the culture of the workplace encourages a “grin and bear it” attitude. Perhaps a worker is concerned about losing the job or being judged harshly by a manager. Whatever the reason, workers do themselves a disservice by not reporting workplace injuries. Failing to do so can jeopardize workers’ compensation benefits to which workers are entitled by law. The basic rule workers should follow is to always report every incident where an injury has occurred on the job. In cases where the injury is serious, the first step is always to seek medical care. But once the initial treatment is provided, it’s important to report the incident. Nevada provides a prescribed form for this purpose: Form C-1 Notice of Injury or Occupational Disease. The employee must submit the form to his or her employer no later than seven days after the incident, or after discovering an occupational disease. If the injury doesn’t require medical intervention, Form C-1 may be the only reporting step required. But when an injury does call for further health care, the fact that the employee submitted the initial report ensures that treatment will be covered by the employer’s workers’ compensation insurance. Other reports become necessary when the employee goes to the doctor for treatment. The physician’s office will assist the employee to complete the next forms in the process, which are used to begin the insurance claims process through which the health care provider gets paid. Nevada employers must comply with state and federal laws that require employers to report serious injury incidents. In Nevada an employer has 24 hours from the time it receives notice of a qualifying injury to notify the Division of Industrial Relations of any employee injury requiring hospitalization, amputation, or the loss of an eye. Among other things, these reports trigger an inspection by the state. What if the employee didn’t complete Form C-1 at the time of the injury, but it later becomes evident that the injury isn’t superficial but requires medical intervention? In this case employees should still submit the paperwork and tell their health care provider that the injury is work-related. There can be legitimate reasons why an injury doesn’t appear serious at first. For example, an injury that gets infected, or a muscle strain that later turns out to be a tear, could still qualify for benefits even though it wasn’t reported immediately after the event. However, employees in this circumstance can expect to face questions from insurance adjusters who are paid to find excuses to deny coverage. Working with an experienced workers’ compensation attorney from the beginning of the claims process can address many problems before they arise. The law firm of Greenman Goldberg Raby Martinez has served injured workers for over 45 years. If you have questions about a work-related injury and how to get workers’ compensation benefits, call us today for a free attorney consultation. Reach us at 702-388-4476 or send us a request through our site.