Getting hurt at work is stressful enough without having to worry about whether you’ll receive the compensation you deserve. Unfortunately, many injured workers find themselves in a frustrating limbo when their workers’ compensation claim doesn’t move forward as expected.
The waiting game can feel endless, especially when medical bills are piling up and you’re unable to return to work. If your claim has stalled, that doesn’t mean you’re powerless. There are concrete steps you can take to get things moving again, and that’s what this blog is all about, so read on.
Why Do Claims Get Delayed
Insurance carriers don’t always move at the speed injured workers need them to, and several common factors contribute to these delays. Sometimes the holdup stems from incomplete paperwork. A missing signature, an unclear injury description, or insufficient medical documentation can bring everything to a screeching halt.
At other times, the insurance carrier may be investigating your claim more thoroughly. This happens if they suspect the injury didn’t happen at work or if they’re questioning the severity of your condition.
In some cases, your employer might be disputing the claim entirely. They could argue that your injury isn’t work-related or that you’re not as injured as you say you are. These disputes naturally slow down the process as both sides gather evidence and present their cases.
Know Your Timeline Expectations
One question that plagues most injured workers is: How long does it take to get workers compensation benefits? The honest answer is that it varies considerably depending on your state and the complexity of your case. Insurance carriers have anywhere from 14 to 90 days to approve or deny a claim after you file it, but these timeframes differ across state-specific rules.
Some straightforward claims are approved within a few weeks, while more complex cases involving serious workplace injuries or contested circumstances can take months to resolve. Understanding what’s reasonable for your situation helps you determine whether you’re experiencing a normal processing delay or if something has genuinely stalled, requiring your intervention.
Document Everything
When your claim isn’t progressing, your first move should be to become meticulous about documentation. Start keeping a detailed record of every interaction related to your claim. This includes every phone call with the insurance carrier, every visit to medical staff, and every conversation with your employer.
Note the dates, times, names of people you spoke with, and what was discussed. If you’re undergoing medical treatment, keep copies of all your medical records, bills, diagnostic tests, and doctors’ notes. This paper trail becomes invaluable if you need to escalate your case later.
Your medical care documentation is particularly crucial. Ensure that your healthcare provider clearly connects your injury or illness to your workplace. Vague medical records can give insurance carriers an excuse to delay or deny benefits, so ensure your doctor is being specific about how your work-related injury occurred and what limitations it creates.
Contact the Insurance Carrier Directly
Sometimes a stalled claim just needs a nudge. Contact the insurance carrier handling your case and request a status update. Be polite but persistent because you have every right to know what’s happening with your claim.
Ask specific questions:
- Has the adjuster received all necessary documentation?
- Is there anything else they need from you?
- What’s causing the delay?
- When can you expect a decision?
If you’re told they’re waiting on something from your employer or medical provider, follow up with those parties directly to expedite the process.
Keep your claim number handy during these conversations. It’ll help the insurance company locate your file quickly and show you’re organized and serious about your case.
Reach Out to Your State Agency
If direct contact with the insurance carrier doesn’t yield results, it’s time to escalate to your state workers’ compensation office or Division of Workers’ Compensation. These state agencies exist partly to assist injured workers in navigating the system and resolving disputes.
Many states have ombudsmen or information specialists who can answer questions, explain your rights as an injured employee, and sometimes intervene on your behalf to move a claim along. They can inform you whether your claim is taking longer than it should and what options you have for resolving the issue.
Your state agency can also provide information about filing a formal complaint if you believe the insurance carrier or your employer isn’t handling your claim appropriately. This formal route creates an official record of your concerns and can prompt action when informal approaches haven’t worked.
Consider Legal Representation
When your claim remains stalled despite your efforts (or if the insurance carrier has denied your claim outright), consulting with a workers’ compensation attorney becomes a smart move.
Many injured workers hesitate to hire a lawyer, worrying about costs or thinking it seems too adversarial. But workers’ comp lawyers typically work on contingency, meaning they only get paid if you win your case, taking a percentage of your settlement or benefits.
An experienced attorney understands Workers’ Compensation Law inside and out. They know what documentation strengthens your case, how to negotiate with insurance carriers effectively, and when to appeal the decision if necessary. They’ve seen every delay tactic and excuse that insurance companies use, and they know how to counter them.
Beyond just legal expertise, having representation signals to the insurance carrier that you’re serious. Claims with attorney involvement often move faster simply because insurance companies know that lawyers will push back against unreasonable delays and will file formal appeals when needed.
File a Formal Appeal
If your claim has been denied or you’ve been offered compensation benefits that seem inadequate, you have the right to appeal. Each state has its own appeals process, but generally, you’ll need to file a hearing request within a specific timeframe after receiving the denial or decision.
The appeals process might involve mediation, arbitration hearings, or appearing before a deputy workers’ compensation commissioner or the Workers’ Compensation Board. These proceedings give you a formal opportunity to present evidence supporting your claim, including medical records, witness testimony, and expert opinions.
Don’t let the formal nature of these proceedings intimidate you. Many states offer Alternative Dispute Resolution Programs designed to resolve contested cases without full hearings, which can be less stressful and faster than traditional appeals.
Know Your Rights
Throughout this process, remember that workers’ compensation benefits exist to protect you when workplace injuries occur. You have employee rights that the law recognizes, including the right to file a claim without retaliation, the right to medical benefits and wage replacement, and the right to appeal unfavorable decisions.
Don’t let anyone make you feel like you’re doing something wrong by pursuing your legitimate claim. You’re simply seeking the medical care and disability benefits that the workers’ comp system was designed to provide.
Moving Forward
A stalled workers’ compensation claim feels frustrating and isolating, but you have more options than you might realize. Whether it’s following up persistently with the insurance carrier, escalating to your state agency, or engaging legal representation, taking action puts you back in control.
Stay organized, document everything, and don’t give up. Your health and financial stability during recovery are too important to let bureaucratic delays derail them. The workers’ comp system has its flaws, but knowing how to navigate it (and when to push back) can make all the difference in getting the benefits you’ve earned and deserve.
James Ruez has spent over five years advocating for injured workers and simplifying complex legal processes. Through his writing, he helps everyday people understand their rights and navigate the often-confusing world of workers’ compensation. When not writing, James volunteers at local community legal clinics.
Editor’s note: Labour legislation differs from country to country so readers are advised to check with legal practitioners in their country for legal advice that is relevant to their circumstances.
