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What Steps to Take After Your Workers’ Compensation Claim is Denied

What Steps to Take After Your Workers’ Compensation Claim is Denied

workers' compensation claim denial

What Steps to Take After Your Workers’ Compensation Claim is Denied

Was your workers’ compensation claim denied? You may be feeling disappointed but, there is legal recourse for this situation.

 

Filing an appeal for workers’ compensation denial can be rewarding but, it is a complicated legal process governed by state laws. An experienced workers’ compensation lawyer can guide you through the steps and help you fill out the documents required for the process and get you the compensation you are entitled to.

 

The first step to determine the future course of action is to understand the reasons for the denial of compensation. They are usually mentioned in the denial letter. Below are the common reasons for claim denial:

 

You didn’t get injured at work

 

You are eligible for claiming compensation benefits if you got injured at work. Injuries that took place during while commuting, on a lunch break or when you were not at your workplace may be denied compensation.

 

However, if you were traveling for a work assignment when you got injured, you may be right in filing a claim. If there is no surveillance footage or witnesses to prove the opposite, you may need an attorney’s help to challenge your denial.

 

You did not notify your employer of the injury on time

 

In case you get injured at work, the law requires you to notify your employer or supervisor as soon as possible. The deadline for reporting injuries varies by state. If you fail to notify in time, your employer might not be able to conduct an accident investigation, or he might argue that your case is fabricated else you would have notified earlier.

 

The claim wasn’t filed on time

 

Typically, an initial claim needs to be filed within 90 days of getting injured. Even if the injury developed slowly, deadlines apply. These again vary by state.

 

You were not treated by an approved medical examiner

 

Under the workers’ compensation system, your employer might recommend you to visit medical examiners that are approved by him/her or the insurance company. The downside to seeking investigation from your employer’s doctors is that they may try to downplay the gravity of the situation which can lead to you getting lesser benefits than what is actually required for treatment. But if you seek medical advice from some other practitioner, this can be a ground for claim denial.

 

You didn’t receive any medical treatment

 

If you are going to claim compensation for an injury, you will have to support your claim with medical reports and bills from a doctor. If you never received any medical treatment, your employer’s insurance providers can argue that your injuries are concocted.

 

Your employer disputes your claim

 

Your employer can and will try to dispute your claim attributing your injury to a pre-existing medical condition, made up or negligence on your part, or any other ground.

 

You were under the influence of alcohol or drugs when the injury happened

 

If you were intoxicated when you got injured, there’s a good chance your claim will be disqualified.

 

A pre-existing condition led to the injury

 

If you had an illness or injury before you took employment and which didn’t get worse as a result of your job, you’re typically not entitled to any benefits. But there are many gray areas and an attorney who knows their workers’ compensation facts will be able to confidently contest the decision.

 

Horseplay or roughhousing was responsible for the injury

 

In the eyes of the law, injuries at work are not entitled to compensation if they are a result of horseplay or roughhousing. If you get involved in a fight at work and seek compensation for the damage, you generally won’t be found eligible.

 

They think you are “cheating”

 

Employers, judges, and attorneys are not easily fooled when it comes to sniffing out those who seem like they are trying to “cheat” the workers’ compensation system. If you do not get caught right away, you will get caught down the road at some point. This will automatically result in your case getting denied.

 

How to appeal a workers’ comp denial

 

If your workers’ comp was denied, you may want to appeal it. The appeals process varies in different states. But usually, a hearing is conducted before an administrative law judge either through the labor department or the state’s comp board.

 

You must bear in mind that your employer or its insurance carrier can and will try their level best to dispute your appeal. A skilled attorney will closely evaluate your appeal and prepare a convincing defense for any objections your employer may raise.

 

 

Contact Us Today

 

The attorneys at The Law Offices of Craig A. Altman are very skilled in the practice of workers’ compensation. To get a free evaluation of your appeal and guidance in the steps and documents required to prepare a strong case. Give us a call at 856-327-8899.

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