If you’re an employee, you have a chance of getting your employer’s insurance company to pay for medical treatment for a work-related injury. Filing a failure to diagnose a claim can help you do that. This guide will help you understand the basics of filing a failure to diagnose a claim and the key things you should know about it.

Image Credit – Image Source

What is a Failure to Diagnose Claim?

Filing a failure to diagnose claim is a way to report your work injuries to the insurance company that provided your medical benefits. Suppose you file this claim, but the insurance company decides that the company’s negligence did not cause the injury. In that case, the insurance company will cover the medical treatment you need. There are a couple of ways that your insurance company could decide that you are not entitled to coverage for an injury. The most common failure to diagnose situations occurs when an employee fails to show signs of an injury that would have caused the employer to take immediate action. Before filing a failure to diagnose a claim, it’s essential to know how your employer failed to diagnose a work-related injury. 

How to File a Failure to Diagnose Claim

Before you file this claim, you will want to gather as much information as possible about the injuries you suffered from your employer. Keep good records of the date and time of the incident, the nature of the injury or illness that you suffered, and when you first became aware of the injury. If possible, you will also want to take photos or videos of the injury. This will help you document the nature of your injury and how your employer failed to diagnose it. You can then use this information to support your failure to diagnose claim.

What You’ll Need to File a Failure to Diagnose claim

Original Workers’ Compensation Claim Application: This is where you’ll tell your employer’s insurance company your medical history and the basis for your workers’ compensation claim.

 Medical Records: You’ll want to gather as much medical evidence as possible to support your failure to diagnose claim. That evidence could come in your medical records, x-rays, or other documentation. It could also come in the form of witnesses who saw the injury or knew about it before you did.

Copies of Work Records: If you were hurt on the job, you’d want to ensure that your employer knows about it and is documenting it. Ensure that your employer has written proof of your injury and gather as much information about it as possible.

What Happens During the Failing to Diagnose Claim Filing Process?

The workers’ compensation insurance company will review your failure to diagnose lawyer claim and decide whether or not to pay for your medical treatment. To do this, the insurance company will:

Contact your employer and ask for written proof of your injury. Your employer will then have 30 days to provide this written proof, or the insurance company will assume that you were not injured at work. Your employer will know if this process was successful because the insurance company will send you a letter.

Send you a bill for the medical treatment you need and a payment schedule. If your employer fails to provide the bill within 30 days, your insurance company will assume that you are not entitled to payment and send you a payment schedule.

Consult with an expert if you submit a failure to diagnose claim. Suppose your employer denies your injury and your workers’ compensation insurance company decides to pursue a failure to diagnose claim. In that case, your insurance company will consult with an expert to help make the decision. Essentially, the workers’ compensation insurance company will hire a third-party expert to help them decide whether or not your employer is negligent and should pay for your medical treatment.

Link

The New York Times. (2022, April 22). The New York Times – Breaking News, US News, World News and Videos. https://www.nytimes.com/

JUSTIA. (2019, February 27). Misdiagnosis and failure to diagnose. Justia. https://www.justia.com/injury/medical-malpractice/common-types-of-medical-malpractice/misdiagnosis-and-failure-to-diagnose/