Workplace injuries are generally covered by an employer's insurance premium based on the workers' compensation audit. Many states require employers to be covered in accordance with the typical level of risk for that specific industry. But if your claim for workers' comp is denied, you continue to have options. You may be ready to appeal the denial through your state's board of workers' compensation. However, there is a spread of reasons why a claim could also be denied.
This article will assist you to find out what steps to require if your claim for workers' comp is denied, although specifics will vary by state. See FindLaw's Workers' Compensation Basics section to find out more.
Why Workers' Comp Claims are Denied
If your claim for workers' comp was denied, the primary thing you would like to try to do is to determine the rationale why. This should be explained in the denial letter. You could be denied for simply not meeting the eligibility requirements, like getting injured while engaging in "horseplay" or get through from work. But if you think the denial was reached in error, you'll appeal. Common reasons for a denial of workers' comp benefits include (but aren't limited to) the following:
The injury wasn't reported in time: State laws determine how soon you want to report an injury to your supervisor, typically within a couple of days (in Colorado, employers must be notified in writing within four days)
- The claim was not filed in time: State laws also determine deadlines for filing an initial claim, typically 30 to 90 days
- Employer disputes claim: Your employer may claim the accident happened outside of labor, was the results of horseplay, or another disqualifying reason
- Injury isn't compensable: Claims for stress-related injuries, for instance, are very difficult to prove in many nations (in contrast, California specifically covers stress-related injuries)
- No medical treatment: In most cases, you want to obtain medical treatment so as to receive workers' comp benefits
- Insufficient evidence that injury is work-related: it isn't always clear whether an injury happened at work, but another checkup and extra evidence may help your case
There are plenty of other reasons why your workers' comp claim may have been denied.
Appealing a Workers' Comp Denial
Now that you simply know why your claim was denied, you'll want to appeal the choice. The denial letter should provide a deadline for filing your appeal, which is decided by state law. In Maryland, for instance, you want to file your appeal within 30 days of receiving the letter of denial. Before you launch an appeal, though, you'll want to satisfy together with your employer (or its insurance carrier) to work out whether the dispute is definitely resolved. It might be a clerical error or an easy misunderstanding.
If you continue to want to appeal the choice, bear in mind that it is often a sophisticated legal process best handled by an experienced workers' comp attorney. The appeals process varies by state but often involves a hearing before a law judge, either through the Department of Labor or state workers' compensation board. There could also be multiple levels of appeal but check your state's laws for specifics.
You will want to bring any documentation, including medical records that address the reason(s) for the denial. This could be the results of a second checkup, a written record showing that you simply were performing at the time of the injury, or other evidence. If you propose on appealing, though, confirm you fully understand the procedures in your state. See the instructions for appealing a choice with the Pennsylvania Workers' Compensation appeals board for an example.
Get Professional Legal Help With Your Workers' Comp Appeal
Was your workers' compensation claim denied? You may feel deflated by the denial letter, but don't despair. Your denial could also be successfully appealed in many cases, but you'll likely want to figure with an experienced legal professional. Accepting a denial of advantages are often financially devastating, so you'll want to satisfy with a workers' comp lawyer.
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