- Missed deadlines can invalidate claims, leaving employees stranded. Perhaps the simplest and most frustrating problem an injured worker can face is a missed deadline. Deadlines are present in every step of the claims process. Initial claims for compensation must be made within 90 days of the employee becoming aware of an injury or illness. Workers also have 90 days from their claim to exercise their right to choose a different doctor from the one selected by the insurer. Although employers and healthcare providers are required to provide notice of these deadlines to employees, many either fail to give notice or bury them within paperwork in hopes that the employee will unwittingly give up rights through inattention.
- Conflicts of interest create moral hazards for employers and insurers. Although the workers’ compensation system is designed to protect employees, its mechanisms are weighted heavily in favor of employers and insurers. An employee with a clear understanding of the competing interests involved at each stage of the process can better protect his or her own rights. This is especially true for decisions about health, from diagnosis to choice of treatments, but can also feed into the kinds of financial benefits an employee receives.
- Workers need to understand their options if injury prevents them from resuming their old job. In serious cases where an injury leaves an employee temporarily or permanently disabled, insurers and employers will sometimes try to avoid their legal responsibilities by not offering required accommodations, mischaracterizing the employee’s disability, or other tactics. In a more transparent system, not only does the employee better understand the options available, but employers also avoid potentially costly litigation and regulatory action.
People who are injured at work can sometimes be frustrated by the complexity of the workers’ compensation claims process. Elaborate rules and tight deadlines add stress to an already difficult situation. And in many cases it can feel like powerful forces are working against the employee, as insurers and employers take steps to protect their own interests. Greater transparency at each stage can improve the claims process. The object of workers’ compensation systems is to ensure that people injured on the job get the care they need without being driven into financial hardship. Ideally, injured employees receive personalized care that gets them back to work as soon as possible. Employers, who are required to carry workers’ compensation insurance, benefit from liability protection and, in many cases, from having workers restored to productivity. The workers’ compensation claims process is full of technical pitfalls for injured workers. Some are to preserve fairness for employers and insurers, who need to account for their risks. But others can feel arbitrary and unfair. In a transparent system the employee knows about the pitfalls before they arise, so they can be avoided or overcome. Here are some examples showing why transparency matters: