You don’t have to work with heavy equipment or in a factory to suffer an injury while at work. People are injured even in office environments. The reality is, that accidents can happen anywhere and people can sustain injury as a result. Workers’ compensation insurance coverage is carried by most employers. It allows for the injured to receive compensation with help for lost wages and medical expenses in the event that they must be out of work to recover.
It’s important to understand the steps that must be taken when your workers’ compensation claim has been denied. Although it can leave people facing potential hardships they hadn’t planned on, denial of a claim doesn’t always mean that there are no more options left to pursue.
Reasons a Claim may be Denied
Understanding the reason for your claim being denied will help you to determine the appeal process regarding the denial of the claim. The most common reasons for a claim to be denied includes:
- Not enough proof that the injury happened while on the job.
- Medical treatment was not sought out or was unnecessary.
- 30-90 days had passed before filing a claim, which is considered not a reasonable amount of time.
- As required by state laws, the injury was not reported within a reasonable timeframe
- Claim that mental and emotional injuries were sustained due to the stress of the job. This is not covered by workers’ compensation.
- The employer disputed the claim because they do not believe the injury happened while at work.
When you are made aware of the reason for the denial, you can figure out how best to move forward. You may learn that more evidence was needed towards your claim. Understanding your options will be helpful prior to the appeals process.
Filing an Appeal
It is a good idea to hire an attorney, like a workers compensation lawyer Milwaukee WI can count on, especially if you must go through the appeals process. You will have 30 days following the denial of your claim to file an appeal. Depending on the severity of the injury and the amount of evidence that was provided, the appeals process can take several months to reach a resolution. If your claim has been denied, it may be advised to communicate with your employer as the denial may not have come from them. In doing so, your chances increase for your appeal to be one that is favorable to you.
Working through the complexities of an appeals process can be challenging to do on your own. Retaining an attorney who is skilled in the area will be helpful in ensuring that your appeal is filed correctly and in a timely manner.
Thanks to our friends and contributors from Hickey & Turim, SC for their insight into workers compensation.