Delayed payment of weekly and/or medical compensation benefits.
Negative experience when notifying employer of injury. For example, being discouraged from reporting, disbelief of stated circumstances of injury or employer requests the insurer dispute liability for the claim.
Unresolved disputed over causation, liability or return to work requiring recourse to an external decision maker.
Lack of early assessment of barriers to recovery at/return to work by insurer/employer.
Inappropriate insurer case management strategies to address barriers to return to work. For example, a generic plan covering a range of general contingencies, non-referral for indicated services, inactivity or "wait and see" approach in the presence of yellow flags.
Perception of uncaring or ineffective case management. For example, the case manager does not return calls promptly, disagrees that treatment is reasonably necessary, or does not approve further sessions in a timely manner with minimal explanation.
History of extended time off work with payment by compensation.
Worker engages a representative (legal, family or union) to negotiate matters with insurer or employer in circumstances that would not ordinarily require representation.