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How Long Does A Workers Comp Investigation Take

After filing your claim, you may wonder, “how long does a workers' compensation case take?” Despite having a system in place to help increase the speed of the claims process in Iowa, it can take a long time to complete a workers' comp investigation.

The Parties Who Approve and Deny Claims

Most employers across the U.S. must have some form of workers' compensation insurance coverage. Employers can choose policies from private insurance companies, or they can insure themselves with the state's approval.

Typically, self-insured employers will need to prove that they possess significant assets and are financially stable, seeing as they will be responsible for paying out workers' comp claims on their own.

After an employee files a workers' comp claim, either the self-insured employer or the employer's insurance company will decide to approve or deny the claim. Before completing the claims process, either the workers' comp insurance company or the employer's privately hired claims administrator will conduct an investigation into and manage the claim.

How Long Does a Workers' Compensation Case Take?

In Iowa, workers need to report their injuries or illnesses to employers within 90 days following the initial accident or discovery of the injury or illness. Otherwise, if this period passes, employees won't qualify for a workers' comp claim. In Iowa, employees have two years to file a workers' comp claim and begin seeking benefits.

After filing the initial claim, the employer's investigator the insurance company will begin investigating the claim.

What Do Workers' Compensation Insurance Adjusters or Investigators Look For?

If you file a workers’ compensation claim, an insurance adjuster will investigate the claim to see whether benefits are owed or whether there is a way for them to avoid the payment of the same. Many insurance companies expend significant funds to try to disprove a claim or catch an injured worker in some way that reduces the value of the claim. Workers’ compensation insurance companies on many occasions hire private investigators who monitor injured workers and try to catch them violating restrictions or undertaking activities that would be damaging to them as their claim proceeds.

Video surveillance is one of the primary ways that Iowa workers’ compensation insurance companies investigate claimants. They will hire an investigator that will camp outside the claimant’s home, work, or places where they go for medical care and videotape them to try to catch them violating restrictions or undertaking activities that are beyond their restrictions. As long as it is in a public place and public area, they can undertake this video surveillance under the law. It is not illegal to do so. Another way investigators try to reduce the value of a workers’ compensation claim is by interviewing friends, family, or coworkers to try to obtain dirt or bad information that could be damaging to their claim.

It is important to be aware that these investigators exist, and that they may be trying to catch you. The main thing an injured worker needs to do is to make sure that they are following their restrictions, attending their doctors’ appointments, and also being aware that someone may be seeing their activities if they are in a public setting.

It's important for claimants to cooperate with insurance companies and provide them with documentation and information as asked, as this could help support their claim.

Employees may benefit from speaking with an Iowa workers' comp lawyer if they have any questions about the investigation and what it involves. For example, a claimant may be concerned about a lack of communication with the insurance company, which an attorney may help mitigate.

Waiting for a Decision

In Iowa and most other states, insurers must make a decision whether to approve or deny a workers' comp claim within a reasonable amount of time. If this party fails to make a decision within this time, they may need to pay a penalty.

In most cases, claimants should see a decision made within a few weeks upon filing their claim. They can also contact insurance adjusters or claims administrators if they don't hear a response. Otherwise, employees can contact workers' comp lawyers to seek a response.

What Happens if Insurers or Employers Deny the Claim?

If insurers or employers deny the claim, individuals can appeal the decision with Iowa's workers' compensation agency. When denying a claim, the parties responsible for the decision should send a letter that explains why they're denying the claim. Depending on the reason given in the letter and the nature of the injury, some victims may be able to successfully appeal the decision through a workers' compensation hearing.

Attorneys can help file appeals if they believe the appeal may result in a successful outcome. These lawyers can help ensure the claimant properly files the appeal.

How Long Does It Take to Receive a Settlement?

Workers Comp case resolution chartOftentimes, workers will be able to receive a portion of their workers' comp payments throughout the claims process before insurers or employers officially resolve the claim. Some of these benefits include temporary partial disability or temporary total disability payments when the employee is unable to return to work while recovering.

The majority of workers' comp cases take as long as years to settle. One survey found that it takes an average of 15.7 months for claimants to have their cases resolved, whether through out-of-court settlements or hearings with judges. Meanwhile, only 19% resolved their cases within six months, and it took between 13 and 24 months for 50% of employees.

If you settle your Iowa workers’ compensation case, it has to be formally submitted to the Iowa Workers’ Compensation Commissioner for approval. This approval process is put in place to protect injured workers by making sure that they are not being taken advantage of by the insurance company or employer. Documents are prepared by the injured worker’s attorney as well as the insurance company’s attorney and submitted to the Iowa Workers’ Compensation Commissioner. Assuming everything is appropriate, the Workers’ Compensation Commissioner will approve the documents. That approval finalizes the settlement of the case, and at that point, the funds can be paid.

Once an approval is received, a claimant may wonder, “when should I start to receive workers' compensation payments?” From the date of a settlement until receipt of the check is typically around 30 days. This is because it usually takes about a week to finalize the settlement documents, another week or two to obtain approval from the Workers’ Compensation Commissioner, and then finally another week to have the check cut from the insurance company and mailed.

If the case goes to hearing and a decision is obtained, the benefits are supposed to be issued promptly and without delay. Sometimes a delay does exist because one side or the other appeals the decision, and while the case is on appeal there can be a basis to delay payment.

The Factors Contributing to the Length of Workers' Comp Cases in Iowa

Multiple factors determine how long a workers' comp case will take to resolve. For instance, some injuries may be too complex to allow for a simple investigation and decision. These injuries may also require longer recovery periods that put employees out of work either temporarily or permanently. Other influencing factors may include the involvement of an attorney, and whether the case stays out of court or eventually goes to trial.

Generally, the more complicated a case is, and the more elements involved, the longer a case may take to settle.

The length of time it takes to complete a workers' comp investigation will ultimately depend on the same factors that influence the outcome of the case. Investigators will want to determine whether a claim is valid, which can take weeks to conduct.