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Failing to report an injury immediately after it occurs often results in insurance adjusters denying that claim. Under New Jersey law, an employer must provide notice of an accident within 90 days of it occurring, so the sooner you report the accident, the better.
Additionally, if a claim is not reported in a timely manner, you’ll miss the opportunity to obtain the appropriate medical care to treat the injury and to later prove through those medical records that the injury occurred.
Medical attention documents the injury. The further from the date of the accident you are, the more difficult it is to prove that you were injured because of the accident. Why? Life happens. If you have a meaningless fender-bender the week after your work accident, the insurance carrier will undoubtedly argue that you had an intervening injury. Don’t suffer in silence and hope that the injury gets better.
If the pain from an injury is not fading after a day or two, seek medical attention and notify your employer of the injury.
If you don’t follow a doctor’s treatment plan, a compensation judge may not believe you are truly injured, causing a denial of your claim. Following through with physical therapy, light duty, or any other treatment plan is vital to a strong case.
Further, if you reject a treatment plan offered by the insurance carrier, temporary disability benefits could be terminated.
Not providing accurate information on your claim forms and physician intake forms could damage your credibility and lead to a denial of your claim. If you schedule an appointment with your private physician and fail to mention the work accident, to obtain coverage of the visit through health insurance, that office note will come back to haunt you. Inaccurate information (such as failing to disclose a prior injury) could also lead to an accusation of fraud from an insurance carrier. If you purposely provide incorrect information, you could be charged with fraud, which is a criminal offense. So being thorough and careful when filling out your forms is always the right thing to do.
Detailed records of your injury and medical treatment document the claim. Do not assume that the doctor is taking down everything you tell him or her correctly. OBTAIN THE MEDICAL OFFICE NOTES through the patient portals, if possible, and review those notes for accuracy. If the notes are inaccurate or missing any information, ask the doctor’s office to make a correction. Remember, unless it’s written down, it doesn’t legally exist. You can have multiple medical complaints, severe pain, and genuine limitations, but unless a medical professional documents these injuries, the court won’t recognize them.
No matter how friendly and genuine they may seem, insurance adjusters are out to protect the insurance carrier’s interests. Carriers are in business to collect premiums and avoid paying claims. It is the job of the claims adjuster to poke holes in your story to determine if your claim is legitimate or not.
The tactics used by adjusters can be bewildering, subtle, and easy to stumble over. No matter how bright you are or how accurate the information you give, you will need an attorney at your side to negotiate deftly and protect your interests.
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