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What does it mean if your workers’ comp claim is red-flagged?

On Behalf of | Aug 22, 2023 | Workers' Compensation |

When you’ve been injured on the job, all you want to do is get better and get back to work. However, you need workers’ compensation benefits to help you get through this time.

So why is your claim taking so long? If your workers’ compensation claim seems to be mysteriously held up and your benefits delayed, it may have been “red-flagged.” That means that your employer or their insurer (or both) have identified your claim as suspicious and in need of more scrutiny.

You don’t have to do anything wrong to be red-flagged

It can be frustrating to think that your claim is under a microscope. However, you can take comfort in the fact that claims are frequently erroneously flagged as suspicious even when the injured worker did nothing wrong. Employers and insurers don’t like paying claims, so they tend to view them with some suspicion.

Some of the things that commonly get a claim red-flagged include the following:

  • Being in the wrong place, at the wrong time or on the wrong day: Were you walking through a different department when you fell? The fact that you weren’t in your usual place at work could be enough to do it. An injury right before your vacation could make your employer suspect that you’re faking to get extra time, while filing a claim early on a Monday morning can make an employer believe you were injured on the weekend.
  • Being too anxious about your claim, knowing too much or having pre-existing conditions: Did you hurry to file your claim because you were anxious about meeting any deadlines? Are you simply well-informed about your right to benefits? Were you ever injured in the past, or do you have any pre-existing conditions? All of these things can make an employer think that your injuries are exaggerated or outright false claims.
  • Not reporting fast enough, not being 100% clear about what happened or having no witnesses: If you delayed reporting because you weren’t sure if you were actually hurt, you can’t quite remember how the accident occurred or you happened to be alone in the stock room when you got hurt, your employer may say that you are trying to pass off an injury that took place somewhere else as work-related.

In other words, it’s hard not to end up red-flagged, especially if your employer is inclined to be jaded. If your workers’ comp claim isn’t going as smoothly as it should, it may be time to seek some legal assistance.