It can be frustrating and disheartening to learn that your compensation claim for a workplace injury has been denied. It’s important to know if there are any gaps in the legal understanding, and what your rights are to appeal the decision. This blog will cover common reasons claims are denied, and how a workers’ compensation attorney maximizes your chances of success.
Common reasons for denial of workers’ compensation claims
Workplace injuries are generally covered by your employer’s insurance company. However, the compensation may be denied due to some misses or negligence on your end. Here’s why that might be.
Insufficient evidence the injury occurred
You must obtain medical treatment for your work-related injuries to prove eligibility for workers’ compensation benefits. Discuss every symptom of the injury with the doctor, whether they seem severe or not. Get a copy of the medical report for your records. If you don’t have medical documents, the insurance company can deny your claim for lack of evidence.
Disputes about whether the injury is work-related
Your employer may claim the accident happened outside of work, was the result of your misconduct or negligence, or some other disqualifying reason. To support your claim, you’ll need to gather evidence, witness accounts, and medical documents to prove your injury is work-related.
The injury isn’t compensable
Sometimes, insurance companies claim your injuries aren’t severe enough to meet the requirements for a workers’ compensation claim. Besides, claims for trauma, psychological conditions, and stress-related injuries are often difficult to prove. In fact, some states rule out claims for illnesses caused by long-term emotional stress at work.
Missed deadlines
You must report the workplace injury on time to your supervisor. States have different time limits for reporting injuries. For instance, Colorado law requires employers to be notified in writing within four days. Then, you must typically file an initial claim within 30 to 90 days, depending on the state law. If you fail to meet these specific deadlines, your workers’ compensation claim can be denied.
Claim was filed after you left the job
If you file the claim after being laid off, fired, or quit your job, your insurance company may deny the claim. This can be the case when injured while serving your notice period, or maybe you were illegally fired in retaliation for reporting a workplace injury. Some states have special rules for claims filed after you left your job. If you qualify for one of the exceptions in your state’s law, you may be able to contest the denial.
How to appeal a denial
Based on the justification given by the insurance company in the denial letter, you can request they reconsider their decision by providing additional evidence and supporting documents. If you’re unable to settle the matter in your favor, you can file a formal appeal. There are strict deadlines for appealing denials, which vary from state to state. Look for your state’s deadline on the denial letter, and file an appeal on time.
Why seek legal representation?
If you’re injured on the job, you may ask yourself “Do I need a lawyer?” The formal procedure for filing an initial claim or appeal is complex and varies state by state. Hiring a workers’ compensation attorney will help you navigate the complex steps and seek your potentially deserved compensation. Expert legal representation will let you put forward the most persuasive case possible.
With LegalASAP, you receive a workers’ compensation evaluation, for free. All you need to do is fill out the form on our website and we can provide you with a free evaluation. Contact us today if you have any questions or concerns.
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