What Do You Do If Your Workers' Comp Claim Adjuster Won't Pay You?

Verify Claim Acceptance

The first thing to do is verify that you have informed your employer of your injury. When you inform your employer of an injury, it provides a claim form that you fill out. This claim form starts the process. The employer forwards the claim form to the examiner, who has a specific period of time during which she can accept or deny your workers' compensation claim. Examiners have a right to deny a claim on face value, if they think the injury does not qualify under workers' compensation guidelines. If an examiner denies your claim, you will not receive any funds. Contact your immediate supervisor to verify claim acceptance.

To understand whether you will receive temporary disability payments, you must first ascertain the type of claim that you have. If you receive medical treatment, but experience no lost time from work, you will not receive any money. Payments for medical treatment go directly to the doctor from the claims examiner or workers' compensation carrier. Temporary disability payments are only for those workers who experience a loss of work due to their injury. If you receive medical treatment and experience no lost time from work, you will not receive payments.

At the time of publication, in New York, for instance, the worker seeks medical attention first and then notifies his employer of the injury. You are entitled to this medical attention while the claims examiner makes a determination on your claim. If you are off work due to the injury, TD payments must begin within approximately two weeks from the date of the employer's knowledge of your injury in most states. In New York, payments must begin within 18 days, if the lost-time accident exceeds seven days. Cash benefits are not paid in New York for the first seven days, unless the lost time exceeds 14 days.

When the claim examiner accepts your claim and you experience a loss of work, but payments haven't started within two weeks of the injury, contact your state's Division of Workers' Compensation department to file a complaint reporting the lack of payment. Additionally, contact your employer and the claims examiner directly. The claims examiner will include late penalties in the payment made to you. If the claim is accepted, this could just be an oversight, but the examiner is required to begin payments within a set period.

You have a right to appeal any denied claim through the state's workers' compensation appeals process. It does not cost you any money to do so, but in most cases, you should hire a workers' compensation attorney to help with your claim. The workers' compensation court system in California, separate from the regular court system, is called the Workers' Compensation Appeals Board. The WCAB's purpose is to adjudicate contentious workers' compensation claims. States without a separate workers' comp court system bring cases before a workers' compensation law judge.