What to do if my workers comp claim is denied?

A workers’ compensation claim denial can be gut-wrenching. Not only are you unable to work to support yourself and your family, you are also left struggling to pay for medical bills while dealing with your injuries or illness. Unfortunately, many legitimate workers’ compensation claims are denied for a multitude of reasons despite studies showing just one-to-two percent of workers’ comp claims are fraudulent.

If your workers’ comp claim has been denied, it does not have to be the end of your claim. In fact, you have legal options available to you, including the right to appeal the decision and present evidence of your claim.

Why Are Workers’ Comp Claims Denied?

Workers’ compensation claims can be denied for many reasons, but there are several common reasons for denials:

  • There were no witnesses. Unfortunately, insurance companies consider this a red flag for a fraudulent claim, even though you cannot help it if you get hurt when no one is there to see it happen.
  • The injury was caused by a preexisting condition.
  • A failure to report the incident to the employer in a timely fashion.
  • Discrepancies in the claimant’s testimony.
  • Insufficient medical care. It’s vital to seek medical attention as soon as possible, follow up all medical appointments with providers, see the doctor often, and follow all doctor recommendations. Failing to do any of these can result in a denied claim as the insurance company may argue the injury isn’t valid.

Appealing Your Denied Workers’ Comp Claim

  1. When your claim is rejected, you are sent a letter stating the claim was denied and possibly a description of the appeal process. Be sure you read the denial letter carefully and note any deadlines for your appeal. In some cases, the deadline to file an appeal may be as short as 30 days.The letter should explain which benefits have been denied and why. In some cases, workers’ comp claims are denied due to missing or incomplete paperwork, in which case you can contact your employer or insurance company and hopefully clear up the problem. If your employer refuses to allow the claim, an appeal will be necessary. A workers comp attorney can guide you through the process and minimize the risk of a permanent claim rejection.
  2. The workers’ comp appeals process varies by state, but it usually begins with an administrative hearing before an administrative judge through your state’s labor department or state workers’ compensation board.
  3. During the hearing, you will need to present evidence to support your claim. This may involve presenting medical records or additional medical testimony offered by your physician. A workers comp attorney is experienced with what is required to build a strong case. He or she can work with you to fulfill the court’s expectations which will greatly enhance your chances of a claim approval.

The Value of a Workers Comp Attorney

If you decide to appeal your workers’ comp claim denial, be prepared for an arduous process. An experienced workers’ comp attorney can help you through this process, including gathering evidence, navigating the many deadlines within the appeals process, and helping you avoid the pitfalls that may damage your case. We recommend speaking with a Palm Beach County workers compensation attorneyas soon as possible before filing your appeal to help build the strongest case possible.

Thanks to our friends and contributors from the Law Offices of Franks, Koenig & Neuwelt for their insight into the workers compensation process.