Workers Compensation Claim Denied—Now What?
by Joan Bradley
If you've been injured at work, you may feel comfort in the fact that workers compensation is there for those situations. If you have read over the qualifications and kept track of the deadlines only to find out your claim has been denied anyway, you may start to panic. You might feel stress regarding medical bills, lost wages that your family needs to live on, or a possible disability that would cause you to be unable to work in the future. However, you can take more steps to receive the compensation you deserve. If you believe your workers compensation claim was wrongfully denied, here's what you can do:
1. See if it can be easily resolved.
The denial letter the insurance company sends you should explain why they won't accept your claim. The denial could be due to one or many reasons, such as having a pre-existing condition, getting medical treatment from an unapproved doctor, not having any witnesses of your accident, and more. If you believe you were denied in error, talk with your employer and the insurance company first in case this can be easily resolved. You don't want to go through a lengthy legal process if there was simply some kind of clerical error or a misunderstanding of your situation.
2. Hire a workers compensation lawyer.
If you have talked with everyone who could help, but no mistakes were made and you're still denied, you'll want to hire a workers compensation lawyer. Legal battles can get messy and complicated, and you'll likely struggle if you try to take care of everything alone, which could hurt your chances of winning. A lawyer is trained for this and will know how you need to prepare yourself and your evidence to have the best chance. They know the laws of your state and are familiar with court proceedings. Hiring a workers compensation lawyer is your best bet for getting the compensation you deserve.
3. Submit an appeal.
Since your original claim was denied, you will need to submit an appeal. You will need to be sure to file within the time frame the insurance company gives you. Your lawyer will help you keep track of deadlines and fill out the paperwork. You will likely have a mediation first, where both parties come together with a mediator to attempt to reach a settlement without going to a hearing. The mediator cannot force any decisions; they simply guide the process. Your lawyer will help you through it all. If a mediation still can't bring you and the insurance company to an agreement, then there is another step.
4. Present your case at an administrative hearing.
If mediation is unsuccessful, you will go to a hearing, where an administrative judge will decide who is in the wrong. You and your lawyer will gather evidence, such as time sheets proving you were working, medical records, and any witnesses. Stay calm and be professional at all times. Be prepared for the decision to take a few days or maybe even weeks. If the hearing doesn't go your way, you should be able to appeal again. Your lawyer can help advise you in that scenario.
Being denied for your workers compensation claim is highly frustrating and can cause you lots of anxiety, but you still have options. Contact a workers compensation lawyer near you for more information and legal counsel about your specific case.
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About Me
You walk into your favorite grocery store and right away, you slip and fall only to sprain your ankle. You can't perform your job because it requires standing on your feet all day, which means that you can't make any money to support your family while your ankle heals. There was no warning that the floors were wet after being cleaned in the store – so what do you do? It's probably a good idea to think about filing a personal injury lawsuit. Of course, anyone with experience with a personal injury case will tell you just how important it is to work with an attorney throughout the process. I'd like to share insight I've learned through three personal injury cases that I myself have had to go through in the past. I think the information on this website can help people like you, who need some personal injury guidance.