Denied Workers Compensation Claims

The law requires that if a worker is injured on the job, their employer may be liable to pay worker’s compensation benefits.  Those benefits can include reimbursement for medical and rehabilitative costs, lost wages, and if the injury results in permanent disability, possible a lump-sum payment for lifetime benefits.  However, the law requires that a claim be filed with the employer immediately, and that the employer file the claim with the insurer just as quickly.  If a worker’s compensation claim is denied, there can be several reasons for that denial; however, there is a narrow avenue of recourse for the claimant.

Disputing a Denied Workers Comp Claim

If a worker’s compensation claim is denied, the claimant will receive a letter stating why.  The employee may reply, requesting the insurer reconsider their claim; although without additional evidence, the claim is likely to be denied again.  In some cases, the claimant can ask for a hearing before an administrative law judge with the State Board of Workers' Compensation.  However, it is crucial that the claimant strengthen their case and provide additional information to ensure that their claim is granted.  One of the reasons that many people lose such claims is because they did not have an experienced worker’s compensation attorney at their side to help them prepare a strong case.                       

Reasons for Having Your Workers’ Compensation Claim Denied     

• There are several reasons why worker’s compensation claims may be denied, which may include:
  
• The claim was not filed within your state’s time limits for worker’s compensation claims.
• You did not receive medical treatment for your injury, so there is no evidence of it for your claim.
• There is insufficient documentation of the injury with your employer or through established medical professionals.  The more serious the injury, the more documentation your claim will require.
• You had pre-existing conditions that indicate the injury was not the result of a workplace accident.

For simple claims, cases may be resolved with no dispute from either entity.  A simple doctor’s visit with documentation from that visit may be sufficient to prove your claim and receive compensation.  However, for more complicated injuries and treatment that takes more time and money, more extensive documentation may be required.  If you have a complex worker’s compensation claim, it may be wise to consult an attorney to ensure that you have sufficient and appropriate documentation to guarantee that your claim is honoured.

Filing a Successful Worker’s Compensation Claim

The first rule in filing a successful worker’s compensation claim is to file it quickly.  Unless your injury is an emergency, you should report it to your employer first.  They will then direct you where and how to receive the treatment you require.  As soon as possible after treatment, you should file your worker’s compensation claim.  Make sure that it is filed within the time limits and have plenty of medical documentation.  If there are any complexities involved in your case, you may need to consult a skilled worker’s compensation attorney to help you meet all the requirements for a winning claim.