Suffering an illness or injury in the workplace can be an overwhelming time. You not only experience the physical impacts of the situation, but also the financial due to the inability to work and the amassed medical bills. Generally, these work-related injuries and illnesses are covered by the employer’s workers’ compensation insurance; however, that doesn’t not automatically mean an employee will be approved.
Filing for workers’ compensation benefits is often vital, as this provides the financial assistance needed to address lost wages, medical bills and other costs related to the work injury or illness. Unfortunately, some workers’ compensation cases are denied. This does not mean there is not a valid case, which is why those initially denied should understand they have the right to appeal the decision.
Why was your claim denied?
Receiving a denial after you filed a claim for workers’ compensation can make you feel defeated. However, a denial does not mean that there is no hope to get an approval for workers’ comp. By understanding why the denial occurred, this can help you understand what steps you can take to address the denial.
While there are numerous reasons for a denial, the most common reasons will be explored. First, a denial could occur if they believe it was a non-work-related injury. Next, a denial could occur if your employer disputes your claim. Another reason for denial is that there was a late reporting of the injury to the employer by the employee. Other reasons include incomplete or inaccurate documentation, failure to seek medical attention after the injury, the injury is found to not be compensable or there exists discrepancies between the medical reports and the claims.
Filing an appeal
If you do not agree with the denial, you have the opportunity to appeal the decision. To initiate the process, you must file an appeal with the workers’ compensation commission or similar agency. Depending on the reason for denial, you will need to provide clear and consistent evidence to support your appeal. The appeals process involves a hearing before an administrative law judge. Note that this is just the first level of an appeal. If an appeal is denied, it is possible to continue forward with the appeal on the next level.
A workers compensation denial can be a complex matter. Thus, filing an appeal can quickly turn into a complicated process. It is important to have a detailed knowledge about the process and your rights. A legal professional experienced in workers’ compensation is equipped with the knowledge to guide you through the process and answer any questions that arise.