Here’s What to Do When Your Workers’ Compensation Claim is Denied

Here's What to Do When Your Workers' Compensation Claim is Denied

A workers’ compensation claim is given to those who are injured during work or develop certain medical conditions because of their work. In these cases, you are bound to get compensation. If the compensation is denied, you don’t need to be worried. There are certain countermeasures you can take to fight back and try to get your claim. The battle may seem difficult but it’s not an impossible one. If your compensation claim is denied, there’s a certain procedure you should follow to try and win back your compensation. Here’s what you need to do if your compensation claim is denied.

Reasons For Denial Of Claim

First, you need to know the reason why your claim was denied. Insurance companies will usually look for anything to deny your claim, and below are the common reasons why.

1. Missed Deadlines

If you’re injured during work, you need to report it as soon as possible. After you report it, you need to file your claim. If you miss the deadline and report it late then your claim is likely to be denied.

There are certain situations when an employer may say that you weren’t injured during work or your medical condition is not due to work. These scenarios also render your compensation to be denied.

3. Your Conditions Don’t Meet State Guidelines

Every state has different restrictions on workers’ compensation claims. Some conditions, whether physical or psychological, may not meet the compensation requirements, which will make you ineligible for a compensation claim.

4. You Filed The Claim After You Left Your Job

Filing a claim while you’re still employed in the company is important. If you filed it after you’ve left the job, you’re likely to be ineligible for the compensation claim and it will be denied. Maybe you reported it while you were working, and in these conditions, some states have special laws for justice to be served.

What To Do When Claim Is Denied

Your compensation claim is your right. If your claim is denied, don’t give up hope too soon. Read the denial letter sent to you because usually, the letter also contains the reason why your claim was denied. If it’s a clerical error or a mistake in the paperwork, it can be fixed if you contact the claim adjuster. However, this path isn’t that feasible, as it only works if there’s an actual mistake made by your employer or the person handling the paperwork. If this solution doesn’t prove to be successful then you have no option left but to appeal the denial.

Appealing The Denial

Appealing a worker’s compensation claim isn’t a difficult task. The process of appeal varies in each state. The letter of denial will also have information regarding the appeal, and it will state how you can appeal the denial.

Usually, the first level of appeal is at a hearing with an administrative judge. For your appeal to be successful, you’ll need to present solid medical evidence to prove your claim. This is the first level of appeal. There are other levels as well which vary with each state. The compensation lawyers at suggest seeking legal consultation to get an idea of the necessary requirements when appealing in court. You have to get it right at this moment. Moreover, your evidence needs to be appealing to the judge so make sure you present everything you can have which proves you are eligible for the compensation.

When You Need A Lawyer

Your claim may be denied due to a clerical error. However, if that’s not the case then you should consider hiring a compensation claim lawyer immediately. It’s good to lawyer up in these critical conditions. A workers compensation attorney will guide you on the right path and tell you if making an appeal is the right move. Moreover, appeals have a very short timeline and they’re usually very strict as well. You wouldn’t want to lose all your benefits due to a missed deadline. Be punctual in this regard and ensure that you do everything in the given time.

A workers’ compensation claim is your right and you shouldn’t give up if it’s denied. There are a number of steps you can take to fight for your rights. First, you need to find out the reason why it was denied and then try to clear it up. If it doesn’t work, you should make an appeal and present evidence. Moreover, it’s good to hire a professional attorney to ensure that you make the right move at the right time. One missed deadline could prove fatal and ruin everything.

This content was originally published here.

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