If you have an occupational illness or you have been hurt on the job, workplace injuries or illnesses are usually covered by workers' compensation coverage offered by your employer. Your claim can be denied.
While some claims are denied for legitimate reasons, some are denied for no reason at all other than to save your employer and their insurer some money.
There are several reasons for a claim to be denied, but with the help of a workers' compensation attorney you might be able to successfully appeal your claim denial.
Because of the complexity of a claim, you need to enlist the help of a workers' compensation lawyer to ensure you get the benefits that you are entitled to receive after a work incident.
Reasons For Claim Denial
There are a few common reasons that workers' comp claims are denied. In some states, some conditions are not allowed for workers' compensation claims. As an example, some conditions resulting from stress are not allowed for workers' comp claims.
Some injuries might not be considered serious enough to be worthy of a workers' comp claim. If you were engaging in horseplay when you were injured or if you were under the influence of drugs or alcohol, your claim might not be approved as well.
Other things that might impact claim approval include not reporting an injury in time because state laws indicate how long you have to file a claim. Each state has a statute of limitations which says you have to file a claim in a specific timeframe or you can lose benefits, so if you don't file your claim in time it can be denied as well.
Also, your employer might dispute your claim and say that the accident didn't happen at work or that there were other disqualifying reasons. Some injuries are not compensable, such as those related to stress.
If you don't get medical care right away, your claim can be denied. If you don't have adequate evidence to show that your injury was work related your claim might be denied as well. Make sure all evidence and documentation are maintained to support your claim.
Appealing a Denial
If you have been denied workers' compensation benefits, you can appeal the decision. State law establishes a deadline for filing an appeal, but you need the help of a lawyer in such situations. In some cases, a meeting with the employer or insurance company can resolve the issue.
An appeal can be complicated. While it varies significantly, it can go all the away to a hearing before an administrative law judge. With the help of a workers' compensation attorney, many claims are successfully appealed and benefits are either started or resumed after having been stopped.
Most of the time, you have no out of pocket expenses or nothing to lose when you hire a workers' comp lawyer. To ensure you get your claim on track, schedule a free case evaluation with a workers' compensation lawyer today.