When there is an employee injury, you are often entitled to worker injury compensation benefits. These benefits can reimburse you for medical bills or lost wages. If you become temporarily or permanently disabled, workers’ compensation benefits can pay a portion of your salary to provide you with income. In many cases, you are not entitled to sue your employer for a work injury claim, so these benefits may be your only recourse for a work related back injury or any other injuries. As a result, it is especially devastating when an employer or insurance carrier denies your workers’ compensation claim.
Workers Compensation Denied by Employers?
When you are injured on the job, your first step is to inform your employer of the injury. The time limits for informing your employer vary by state: in some states, you need to tell your employer as soon as possible but in other states you may have up to 90 days. You also need to get a medical exam to examine the extent of your workmans comp injury. Your employer will submit notice of the injury to its insurance carrier, and if they accept liability then you will receive a letter detailing the type of workmans comp settlement you can expect.
In some cases, you will need to explicitly file a claim, documenting the fact that your injury occurred on the job, that it arose out of your employment, and that you incurred damages or are disabled. You may have to back this information up with a statement from your doctor. It is a good idea to have an experienced workers compensation lawyer to help you file the claim with your employer’s insurer.
After your employer submits notice or you file your claim, you get a statement of benefits or a notification of denial. This may happen anywhere from shortly after notification of the injury is filed, up to several months after the injury.
Why Claims Are Denied
Claims may be denied for any number of reasons. Common reasons for denial of claims includes:
- Improper documentation. If you did not file notice of the injury with your employer, or your doctor’s statement does not prove disability or injury with sufficient clarity, you might fall under workers compensation exemption.
- The injury is not work related. In order to recover benefits, the injury had to arise out of the course of your employment. If you smoked cigarettes on your lunch break at work and got lung cancer, this is not a work related injury that you can recover for.
- The injury did not occur on the job. If you got hurt commuting to work, depending on the laws of the state, this may or may not be covered. If you got hurt at a social work function where attendance was optional, you may not be covered.
- You were violating policy or otherwise grossly negligent in causing the injury. If you come to work drunk or on drugs, or violate explicit company policy and are injured, you may not be entitled to recover.
- You had a pre-existing condition. If you were already injured, you cannot make your employer pay for that injury (unless something happened on the job that aggravated the injury or caused an old injury to return)
- You are not actually injured or disabled: If the insurer does not believe your injury was real, or that your injury entitles you to short term or long term disability, your claim may be denied
Be aware that sometimes you will receive a partial denial. This means they will accept part but not all of your claim. Although this can look like an acceptance, you still must appeal the denied portion of the claim in order to recover damages related to that injury.
What To Do If a Claim is Denied
If a claim is denied, you will need to file an appeal. The appeals process varies by state, but usually involves a hearing in front of an administrative board. You may have to testify, present expert witnesses at the hearing, and/or submit to an exam by the insurer’s doctors.
You usually have a limited period of time in which to file an appeal, so it is essential to respond quickly to a denial in order to avoid forfeiting benefits.
When To Get a Lawyer Involved
When possible, you should get a lawyer involved before filing a worker’s compensation claim. An experienced worker’s compensation attorney can help you structure your claim to minimize the chances of denial. However, it is essential to get an attorney involved when a claim is denied since the procedures for appealing denials can be complex and are different in each state.
How To get Legal Help
You should find an attorney experienced in job-injury and worker’s compensation claims in order to help you get the recovery you deserve for your injuries. Locate a Workers Compensation Attorney and fill out a Free Legal Case Review.