Delayed payment of weekly and/or medical compensation benefits.
Negative experience when notifying employer of injury. This might include being discouraged from reporting their injury, disbelief of the stated circumstances of injury, or the employer requesting the insurer to dispute liability for the claim.
Unresolved dispute over causation, liability or return to work, resulting in a referral to an external decision maker.
Lack of early assessment of barriers to recovery at/return to work by the insurer or employer.
Inappropriate insurer case management strategies to address the barriers to return to work. For example, a generic plan covering a range of contingencies, non-referral for indicated services, inactivity or a "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.
History of extended time off work receiving compensation payments.
Engages a representative (legal, family or union) to negotiate matters with the insurer or employer in circumstances that would not ordinarily require representation.
