Injuries at the workplace are typically covered by workers’ compensation insurance. However, not all claims are approved. Sometimes, the insurance provider may deny a compensation claim, which, in turn, can make workers helpless. Many states across America require employers to have this kind of insurance coverage. Both the employee and the employer need to know more about workers’ compensation claims and what happens when the claim is denied.
With that said, you still have options if your workers’ compensation claim gets denied. You can appeal via the board of workers’ compensation in your state. However, there are several reasons why your claim might be denied.
Why Was Your Claim Denied?
When your claim gets denied, the first thing you’ll need to find out is why. The denial letter should clearly explain the reason why your claim was denied. Even if you may not have met the eligibility requirements, you can still appeal if you believe there was an error in your denial.
Some of the common reasons why a workers’ compensation claim can be denied include:
Non-work-related injuries: If the insurance provider believes that the injury wasn’t work-related, they can deny your claim. For example, they may reject your case if your injury happened outside of the workplace or if it’s because of a pre-existing condition.
Late Reporting: Workers’ compensation rules and regulations require injured workers to report when they get hurt or injured at the workplace. Most states require you to report the incident within a particular timeframe. The insurance provider may only accept a claim if the incident was reported in time. The statute of limitations in your state will provide you with all the information you need regarding this.
Employer Dispute Claims: Your employer might claim that the accident didn’t happen at work. Your employer might argue that the accident occurred outside of the workplace because of horseplay or any other disqualifying reason.
Appealing a Workers’ Compensation Denial
Once you’ve understood why your claim was denied, you can start to appeal your decision. The appeal procedure usually involves filing a formal appeal. This kind of appeal is typically filed with the workers’ compensation board in your state or a similar agency. If the board also denies your case, the court of appeals can be your next resort.
The denial letter should include a deadline for the filing of an appeal. The state law dictates what the deadline should be. Before you file an appeal, communicate with your employer first and determine whether you can resolve the dispute amicably between the two of you. The whole thing could be a simple misunderstanding or, even worse, a minor clerical error.
If you still want to move forward with your appeal, keep in mind that this whole legal process is typically a very complicated one. In fact, you may want to strongly consider hiring a workers’ compensation lawyer to help you properly navigate through the entire process. This type of attorney is the best equipped to handle such cases because they understand the detailed and complex intricacies of workers’ compensation rules and regulations.
It’s important to provide consistent and clear evidence to support your workers’ compensation claim. This includes providing comprehensive medical records that clearly reveal how bad your injuries are. The legal documents should also include the associated medical expenses.
The process of appeal varies from state to state. However, it usually involves an administrative law judge. This might happen via the workers’ compensation board or the labor department. There might be several levels of appeal. However, you may want to review your state’s legislation regarding the matter for specifics.
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