What Should I Do if my Workers’ Compensation Claim Has Been Denied?

If you have a workers’ compensation claim, but your benefits are denied, your options depend on why the insurer made that decision. Those reasons may seem very small or irrelevant, but insurance companies save money when they find a reason to refuse to pay your claim. Here are a few of the most common and how you may be able to appeal the denial.

Missing Deadlines

Each state has laws regarding workers’ compensation benefits, but all have deadlines governing how long you have to report your injury or sickness. In some states, you also face a deadline for filing a claim with a state agency. Missing any of these critical deadlines gives the insurance company a reason to deny your claim.

Questionable Conditions

If your employer disputes whether or not your injury is work-related, the insurer may deny your claim until you prove your case. The burden falls on the injured party to provide the evidence in the form of witness statements or medical records, for example. The employer may require you to submit to an independent medical examination to prove that your injury is work-related.

Excluded Conditions

Some states’ laws include restrictions on certain types of claims related to trauma or psychological diagnoses. One example is limitations on claims related to long-term exposure to stressful working conditions. The insurer may also claim that your injuries are not severe enough to warrant compensation.

Post-Separation Claims

If you wait to file your claim until after you leave employment, the insurer will almost certainly deny your claim. Sometimes you have a good reason for this timing. For example, maybe you were injured while working out your notice to your employer. Another possibility is that you were fired for reporting a work-related injury, which is illegal. Because of these complicating factors, some states have laws specific to filing a claim after leaving the job, which may provide you with an avenue of appeal.

Avenues of Appeal

The written notice denying your claim will explain why it was rejected and explain your options for appeal. The first round of appeals usually involves appearing in front of an administrative law judge with the state labor department or workers’ compensation board to submit your evidence. Even if you don’t succeed at this level, you may have additional avenues available to you, depending on the laws in your state.

Getting Help

Workers’ compensation laws can be complicated. If your claim is denied, you should seek the help of a knowledgeable and experienced attorney who is familiar with the laws of your state. Contact a workers’ compensation lawyer, from our friends at Law Offices of Franks, Koenig & Neuwelt right away to preserve your rights and access to benefits.