Filing for workers’ compensation benefits can be anything but easy, and it is a common occurrence that the initial request for benefits is denied by the employer or workers’ compensation insurance provider. Just because that initial denial is received does not mean that all hope is lost.
Appeals can be submitted following a denial letter, and many times a workers’ compensation attorney can step in if any mistakes were made in filing that initial claim.
We have asked attorney, Alaina Sullivan, and here is what she had to say:
Why Workers’ Compensation Claims Are Denied
The reasons for the initial denial of a workers’ compensation claim can be numerous. Many times, the insurers will deny a completely valid claim on the first try, forcing the employee to have to jump through hoops and hire legal counsel to get what they deserve.
Many times, denials happen based on a small, but significant error. Claims can be denied for many different reasons, including:
- The injury was not witnessed;
- The insurance company found insufficient evidence that the injury was work-related;
- The employee failed to report the injury immediately;
- The insurance company located a discrepancy between the accident report and the medical records initially submitted;
- The initial medical records showed a presence of illegal drugs in the employee’s system;
- The employee filed for workers’ compensation after he or she was fired or laid off from the company; or
- The employee refused to give the insurance company an official recorded statement and refused to sign medical authorizations.
Handling an Appeal of Workers’ Compensation Denial
The injured employee will likely receive an official letter stating that the claim has been denied, and in that denial letter, the employer or insurance company will provide information regarding what is needed for an appeal.
The letter will include information regarding how long the individual has to make an appeal. It will also explain the reasons for why the denial was made. Many times, the denial comes from a simple mistake made on the application, and if that is the case, the individual may be able to handle it without the assistance of an attorney.
However, if the denial has to do with something more substantive, it is recommended an attorney be contacted for at least a consultation regarding what needs to be done. The appeals process involves more than simply submitting an application again.
While it varies from state to state, most states require the appeal to go before an administrative law judge. In addition, multiple levels of appeal may exist, each with their own set of rules. An attorney who has experience in workers’ compensation will know this information.
In addition, if the appeal is for reasons such as a dispute over whether the injuries are work-related or whether the claim has merit, the attorney will be able to help the injured employee get the needed evidence to prove his or her case.
This evidence will need to come from certified medical records, which will need to be obtained through the provider and properly admitted into evidence at hearing.
The attorney will also need to depose the doctor treating the employee who can attest as to how the injuries were sustained, how they will affect the employee and what the needed treatment is for the injuries. An individual can certainly try to get this evidence on his or her own, but the process is more streamlined and efficient if an attorney is able to do this.
Concerns Regarding Legal Fees
One of the major reasons people hold off on hiring an attorney to help in any legal matter involves the payment of attorney’s fees. However, workers’ compensation attorneys are not paid unless the person is successful in getting his or her claim.
The attorney will be paid through the workers’ compensation provider directly, which means the client will not need to front the money to pay for the attorney initially.
Therefore, the client will be able to get the much-needed legal assistance as soon as possible, making it easier for him or her to get the benefits needed for the employee’s injuries.
Contact an Attorney Today
If you are in the process of pursuing workers’ compensation and have questions about how what to do in the event of an initial denial, a workers’ compensation attorney can help review your case and discuss your options.
An attorney can listen to the facts of the case and can best advise you on how to proceed. Contact an attorney experienced in workers’ compensation law to schedule a consultation today.