When you suffer an accident on the job, you expect workers’ compensation insurance to help pay for your medical bills and cover any wages you lose while you are not able to work. A denial, however, could leave you in a difficult situation. What should you know about responding to a denied workers’ compensation claim?
Understand the reason for the denial.
Make sure to read the denial letter carefully to understand their reasons. Some common issues that lead to a denial include:
- Lack of evidence that the injury is work-related: Your employer or their insurance company could argue that your injury did not occur during your work.
- Missed deadlines: There are strict deadlines for reporting your injury and filing for workers’ compensation. If you miss these, you might receive a denial.
- Discrepancies in the claim: If your story does not match up with your medical records or what witnesses say, the insurance company might deny your claim.
- Pre-existing conditions: If the insurance thinks your injury existed before the workplace accident, they might deny your claim.
Knowing why the insurance provider denied your claim can help you respond effectively.
Consult with a workers’ compensation attorney.
Dealing with a denied claim can be hard, but you do not have to do it alone. A workers’ compensation attorney can guide you through the appeal process and help make your case stronger. They can also give you advice that fits your specific situation to help you appeal successfully.
Gather additional evidence.
Get any extra evidence that supports your claim, like more medical records, new medical opinions, statements from people who saw what happened, or information about your job and what you do at work. This evidence can support your claim and give your appeal a better chance of success.
File an appeal.
You usually have the right to appeal a denied workers’ compensation claim. Look at the denial letter for instructions on how to appeal. You should also keep in mind that appeals have strict deadlines, so you will have only a few weeks to file your appeal.
If your appeal leads to a hearing, be ready to explain your case. You might need to answer questions about your injury and how it happened and show all your evidence. Your lawyer can speak for you at the hearing and make arguments to support you.
A denied workers’ compensation claim can be stressful and upsetting. However, by with the right approach and legal support, you can fight for the benefits you deserve.
