Workers’ Compensation Claim Denials Overview

Workers’ compensation programs exist in order to provide medical care and financial support to individuals who are injured at their place of work, or as a result of an injury that occurred in the course of their work related duties. Injuries could be caused by one single accident that results in a broken bone or concussion, or they could be cumulative injuries that develop over time as a result of a repeated activity. Illnesses are covered as well, such as black lung disease, or mental illnesses if they were caused by work related activities. If a person is injured at work, they should file a workers’ compensation claim so that the workers’ compensation insurance policy pays for the medical costs, and if the employee is unable to work for a time, for disability payments. It is not uncommon, however, for employees to find that their claims have been denied.

If you find yourself facing a denial of workers’ compensation benefits, for an injury you believe is work related, here are a few things to keep in mind.

You have the right to appeal

The letter informing you of the decision to deny you workers’ compensation likely even tells you that you have the right to appeal. Appealing a denial of workers’ compensation benefits will vary by state, but it is likely that you be required to appear at a hearing in front of an administrative law judge. The hearing could involve a testimony from you, your medical records, expert testimonies and opinions and evidence regarding whether your injury was actually work related.

If you were denied benefits, take the steps to appeal right away as there are likely strict time limits restricting your right to appeal.

You should determine why your claim was denied

Worker’s compensation claims are frequently denied, and the decision to deny you benefits might have come with an explanation of why your claim was not successful. Some common reasons for claims to deny include the insurer determining your injury was not significant, the employer arguing your injury was not work related, or, and this is quite common, you missed the window of time in which you had to file your workers’ compensation claim.

You will want to know the reason for your claim being denied so that you can develop an argument against it at the appellate stage. Insurers do not want to pay out for injuries, so they often have their own hired doctor conduct an examination of the injured party. These exams are not neutral, and if they are basing their argument that you are not injured on the exam their doctor conducted, you will have to have evidence from other medical experts that can counter their claim. If your employer is trying to avoid responsibility (perhaps they want to avoid higher insurance costs), and claiming that your injury was not caused by work, then perhaps your doctor can state why it was, or maybe your co-workers witnessed the incident and can support your claim.

An attorney can help you with your appeal

If you are facing the need to appeal a workers’ compensation claim, you should consult with an attorney to develop a strategy for appealing the agency’s decision. An experienced attorney will be able to look at your individual case and the facts, and determine a course of action that is suited to your case and your needs. An attorney will know the process of the hearing and be able to prepare you for what to expect, for the information the Administrative Law Judge will be looking for, and will know how to address expert opinions provided by medical experts. The high costs of medical care, and the impact missed work can have on your ability to provide for yourself and your family mean that the stakes are high. Be sure to take action right away so that you do not lose your opportunity to receive the benefits that you are entitled to.

Contact Stern Law, PLLC for A Free Consultation

At Stern Law, PLLC, we have compassionate and caring attorneys ready to work with you in order to find the best strategy for seeking compensation for your job related injuries. Contact Stern Law, PLLC today at (844) 808-7529 for a free consultation with an experienced attorney.