If you were injured on the work or developed a medical condition due to your work—such as a cumulative trauma sort of a repetitive strain injury (RSI) or lung disease from exposure to toxic chemicals—you’re little question hoping to be eligible for workers’ compensation benefits. But what are you able to do if your claim has been denied? The answer could depend upon the explanations for the denial.
Common Reasons for Denial of Workers' Comp Claims
Employers or their insurance companies sometimes search for any possible reason to deny workers compensation audit. Of course, that reason should be a legitimate one under the law. There are several common reasons for claim denials, including:
- Missed deadlines. In order to receive workers’ comp benefits, you want to report your injury or illness to your employer directly. After that, you generally need to file a workers’ comp claim with the state agency (although in some states, your employer or the insurance firm will lookout of this step after you’ve notified them of the injury). States have different deadlines for reporting injuries and filing claims. If you miss the deadlines, your claim will probably be denied. In some states, you won’t be penalized for missing the reporting deadline (by not giving your employer written notice of the injury), as long as your boss actually knew that it happened. Still, your claim has got to be filed in time.
- Disputes about whether the injury is work-related. Your employer may say that you weren’t working when you were injured, that you were involved in some kind of misconduct at the time, or that your current medical condition isn’t actually a result of a workplace accident or exposure. Whatever the reason for the dispute over whether your injury or illness is work-related, you’ll get to gather evidence to support your claim. Maybe you would like to witness accounts about the circumstances of the accident. Or you may need more medical evidence. If your treating doctor has already attributed your condition to your work, but the insurance company disagrees, you may need to attend an independent medical examination to get another doctor’s opinion.
- Your condition doesn’t meet state guidelines. The law in your state may have special restrictions on workers’ comp claims for cumulative trauma or psychological conditions. Some states rule out workers’ comp benefits for illnesses caused by long-term emotional stress at work. Or your injuries won't be severe enough to satisfy the wants for a workers’ comp claim.
- You filed the claim after you left your job. Insurers usually deny claims that were filed after the worker was fired, laid off, or quit. But you would possibly have had an honest reason for the delay. Maybe you reported the injury while you were still at the work, otherwise, you were injured within the period after you gave (or were given) notice but before your Judgment Day. Or maybe you were fired in retaliation for reporting a workplace injury (which is illegal). Some states have special rules for workers’ comp claims filed after you left your job. If you qualify for one among the exceptions in your state's law, you'll be ready to contest the denial.
What to Do When Your Workers' Comp Claim Is Denied
Don’t hand over your right to workers’ comp benefits simply because your claim was initially denied. First, look closely at the letter telling you that your claim was denied. It will probably include the explanations for the denial. If you think it was simply a matter of mistaken paperwork or something similar, you might consider contacting the claims adjuster to see if you can clear up the problem. But this route isn’t likely to achieve success unless your employer or the insurance firm made a real mistake and admits it. More likely, you’ll have to consider appealing the denial.
Appealing a Workers' Comp Claim Denial
The letter you received may include information about the way to appeal the denial of your claim. If so, read it carefully. The appeals process varies in each state. Often, the primary level of appeal is going to be at a hearing before a law judge, where you’ll need to present medical and other evidence to support your claim. The hearing is often through a state Department of Labor or a state board of workers’ compensation. There are additional levels of appeal beyond the initial administrative levels also, which vary counting on the state.
When You Need a Lawyer
Unless your claim was denied thanks to an easy mistake that was immediately cleared up, it might be smart to talk with a workers' comp lawyer as soon as possible. An attorney can assist you to determine whether an appeal would be the simplest course of action for you. The timelines for workers’ comp appeals are short and strict, and you don’t want to lose your rights to benefits simply because you missed a deadline.
Before you think about filing any appeal yourself, you ought to definitely ask an attorney. Appeals are complicated legal processes, involving rules of evidence and civil procedure that the judge will expect you to understand. If you don’t win at the initial levels, you'll not be ready to present additional evidence later within the process. One of the reasons that many injured employees lose their appeals is because they didn’t have an experienced workers’ compensation attorney at their side to help them prepare a strong case. Also, most workers' comp lawyers charge only a percentage of the advantages you really receive, so it won't cost you anything unless you win.
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