Receiving a denial of your Workman’s Comp claim can be frustrating and disheartening. After all, you’re hurt, your medical bills are piling up, and you may be unable to work for an extended period of time. Unfortunately, this is an all-too-common scenario for injured workers. In a recent survey, we found that 27% of workers’ comp claims were initially denied.
The good news, however, is that you have the right to appeal the decision. The first step is to contact the insurance company. The insurance company for your employer will typically make the initial decision on your workers’ compensation claim. If you receive a denial, your first step should be to contact the insurance company to find out why your claim was denied. Sometimes a claim is denied because the paperwork wasn’t filled out correctly or an important document was missing. The insurance company may allow you to fix these types of technical mistakes and reconsider your claim.
Other claims are denied because the insurance company believes you have not met the eligibility requirements for receiving benefits. For example, the insurance company may deny your claim because your injury happened away from the workplace or during non-working hours. Or, the insurance company may believe that you had a preexisting condition that was the real cause of your injuries.
Whatever the case, you can usually ask the insurance company to reconsider its decision. This can be worthwhile if you have additional facts or documents for the insurance company to consider (for example, medical records showing that your work injury required treatment).
The next step is to file a formal claim or appeal. If you can’t work things out with the insurance company, you will typically need to file a formal claim or appeal. The notice of denial from the insurance company will usually lay out the procedures you must follow to file an appeal. It is important to keep in mind that there are strict deadlines for appealing Worker’s Comp denials.
It’s also important to file your appeal according to the procedures of your state. For example, in some states, your appeal may be as simple as sending a letter to your state’s workers’ compensation agency. In other states, you may need to fill out certain forms, attach certain documents, or send multiple copies of your appeal. If you fail to follow the rules, you may be denied benefits, even if you would have otherwise been entitled to them.
The next step is a Worker’s compensation hearing. Although a workers’ comp hearing is less formal than a trial, it does have some similarities. For example, the parties make legal arguments, present evidence, and elicit testimony from witnesses. There are also certain procedural rules that must be followed, and a workers’ comp judge (or other official) will preside over the hearing.
Although you have the right to represent yourself at the hearing, it’s highly recommended that you have an attorney at this stage.
To succeed at the hearing, you will need to convince the Worker’s Comp judge that the initial denial was wrong. The evidence you should present will depend on your particular case and the reason for the denial. For example, if your appeal was denied because the insurance company believes you were not seriously injured, You should present reports from your doctors showing the severity of your injuries. If your appeal was denied because the insurance company believes you weren’t working at the time of your injury, you might present time cards or a statement from a coworker who witnessed the injury.
Although you have the right to represent yourself at the hearing, it is highly recommended that you have an attorney at this stage. A qualified Worker’s Comp attorney will be able to craft persuasive legal arguments, present relevant evidence, follow procedural rules, and present your case in the best light possible. You’ll also be on equal footing with the insurance company, as it will likely have an attorney as well.