What if the Insurance Company Refuses To Cover All My Injuries?

April 27, 2021
Stern & Cohen
Worried injured woman reading a letter sitting on a couch in the living room at home after being denied workers comp claims

Sometimes when an employer has accepted liability for a work-injury, they have either incorrectly described the injury or not listed the complete extent of an injury. The good news is your employer has at least accepted liability and you are likely getting some of the medical treatment you need and are receiving workers’ compensation checks if you are out of work because of the injury. The bad news is you may not be able to get the full extent of treatment you need because the workers’ compensation insurance may be denying you certain types of treatment for a body part if it is not part of your accepted work injury. What should you do?

You should hire an attorney who can file a Petition to Review on your behalf. This is similar to a Claim Petition in some ways, but a Review Petition seeks to add to the description of your injury. In other words, you are asking a judge to expand the description of injury to accept and acknowledge the full extent of injuries you sustained from the work-injury. 

For example, let’s say you fell at work and landed on your knee, but in the process of falling you landed funny and twisted your back. Based on how you fell and the obvious nature of your injury, your predominant complaint at the time may have been your injured knee, and that is what your employer has accepted liability for. However, since the fall you are continuing to experience back pain. Because your accepted work injury is to your knee, you likely will not be able to get medical treatment for your back through the workers’ compensation insurance. 

However, because you injured it during that same work-injury, you deserve to get treatment for your back through workers’ compensation insurance. Further, if your knee heals quickly and you are medically cleared to return to work for your knee, this can cause problems. As soon as the doctor who was treating your knee clears you to return to full duty, your employer will want you and expect you to return to work. If you are unable to work because of your back, which has not been accepted by your employer, your workers’ compensation checks may be in jeopardy because the basis of you being out of work now (back) is not what the insurance carrier had accepted (knee). 

If you are in a similar situation, you have the right to hire an attorney to file a “Review” Petition and litigate the relationship between your back condition and the work injury. If you realize the description of injury is incorrect, it is important to address it immediately. In the above scenario, if you are proactive, an attorney could file a Review Petition while you are still receiving benefits.  So, you will have financial stability while this is being prosecuted.  At Stern & Cohen, we often pursue Review Petitions to add injuries with no charge to our clients!  Further, we have the ability to assist in arranging medical treatment for our clients even for the injury that has not been recognized by the insurance company yet.  

Of note, a common type of injury Review Petitions are used for are psychological injuries stemming from a work-related physical injury. A claimant may file a Review Petition seeking to add a work-related mental disability as a result of a work-related physical injury for which the employer has accepted liability. 

As most injured workers are aware, work injuries are often time traumatic. Even if the actual injury itself was not traumatic, being out of work and being forced to litigate for the benefits you deserve is mentally exhausting and stressful. As such, some injured workers can suffer from psychological disorders such as depression or anxiety as a result of their work injury. If the injury was traumatic in nature, the injured worker may suffer from post-traumatic stress disorder. 

In the example above, where a worker falls and injures his or her knee and back, the basis for disability and need for treatment is often physical. However, if the injuries were particularly serious and the person is out of work for months or even years, that is taxing on a person, especially when they have gone to work their whole life and now, all of a sudden, they cannot work and provide for their family in a way they used to. Moreover, if, as noted above, for any portion of the time out of work the person has been without workers’ compensation indemnity benefits, you are in a particularly stressful situation financially as a result of your work injury. In these types of scenarios, you may require and benefit from psychological treatment. Because it is related to your work-injury, we can file a Review Petition to ensure it is covered as such. 

In sum, if you do not think that the description of injury that your employer has accepted liability for is correct, or if it is correct but does not cover the extent of your injuries, you should contact an attorney immediately. Our attorneys are extremely experienced in handling these types of issues.  The call is always free.