Last month we discussed when off-work benefits (TTD, short for Temporary Total Disability) should begin and when they can end. This month is about what to do when the insurance company denies your claim or stops benefits.
Generally speaking, there are two main reasons for an insurance company to stop benefits. One is a claim denial, and the other is a return-to-work dispute. Though before such a decision is made, they will probably have you examined by a company-paid doctor for an opinion.
A claim denial usually means the company doctor said your work-duties did not cause your injuries. A return-to-work dispute means he said you could immediately return to work without restrictions. In either case, the insurance company should send you a copy of their doctor’s report.
The first thing to do is bring the report to your doctor and request he write a letter supporting your injury as work-related. If the dispute is about returning to work, then he should explain why you are not ready and on what date you will be. If the dispute is that your work-duties did not cause your injury, then he should explain how your injury relates to your work.
During this period, a special rule, called 19(b), allows your attorney to file a Petition for Immediate Hearing. With this Petition, your attorney can get your case before an arbitrator sooner than other cases and it is also given priority to be heard. However, this process is often used for an informal conference, called a pre-trial. This is where your attorney and the insurance company’s attorney go before they arbitrator to discuss the dispute and see if it can be resolved without a trial. Otherwise, there usually is more work to be done, such as getting the testimony of both doctors.
