Workers' Compensation Law

Denial of Workers' Comp Benefits and Appeals

An injury on the job can take you out of work for months. Under state workers’ compensation laws, employees are entitled to workers’ compensation benefits after a workplace injury. However, if your state workers’ comp commission denies your claim, you could be without income or medical care.

You can file an appeal if your workers’ compensation claim is denied. However, you only have a limited time to request a hearing, and each state has different workers’ comp laws and deadlines. Find an experienced worker’s compensation lawyer in your area to put you in the best position to have your claim approved.

What Is the Workers’ Comp Process?

Most states require employers to provide workers’ compensation coverage for employees. Workers’ compensation provides medical care to pay for workplace injuries. Workers’ comp also provides income replacement for the time when you are unable to work. If you can’t return to work, you may be able to get Social Security Disability benefits.

After a workplace injury, injured employees have to report the accident to their employers within a certain amount of time. If your employer approves the claim, you should immediately begin receiving benefits to cover medical care for your work-related injuries. If you can’t return to work because of your injuries, you should also receive income replacement workers’ comp benefits.

What if My Worker’s Comp Claim Is Denied?

If your employer or the workers’ compensation insurance provider doesn’t believe you were injured on the job, they may dispute the claim. The insurance company has a limited amount of time to decide whether to approve or deny your claim. The notice generally has to include an explanation for why your claim was denied and inform you of your rights to appeal.

Common reasons why an employer or the insurance company might deny your claim include:

  • The injuries do not match the alleged accident or are related to a preexisting condition
  • You did not report the accident in time
  • You violated company policies
  • You were under the influence of drugs or alcohol
  • The injury didn’t happen in the course of employment

If you get a notice of denial from your claims administrator, you can file an objection and request a hearing.

How Much Time Do I Have To Request a Hearing?

There is a time limit to workers’ compensation claim disputes. The amount of time depends on your state. Contact your state’s workers’ compensation board to find out about deadlines for asking for a hearing. You can also contact a workers’ compensation attorney as soon as you get notice of the denial. An attorney can act quickly to make sure your appeal is filed in time.

Workers’ Comp Disputes

After filing a dispute with the workers’ comp board, the board may try to resolve the dispute informally. If you can’t resolve the dispute with the insurance carrier, your case may go to a trial before a judge.

An administrative law judge (ALJ) can review your case, medical records, and evidence, including any witness testimony. After the trial, the judge will send you a written decision. If the judge denies your claim, you can file a petition or appeal. Again, you only have a limited time to appeal the court’s decision.

How Can I Pay for Medical Care While Waiting for Benefits?

If your employer denied your claim, you still need to get medical treatment for your injuries. Medical bills can pile up when your employer isn’t paying for your treatment. While your claim is being disputed, your own health insurance may cover your treatment. If you can’t afford insurance, you may be eligible for Medicaid coverage. Your workers’ comp lawyer may also be able to negotiate with your medical provider to lower your bills.

Do I Need a Lawyer for a Worker’s Comp Appeal?

Injured workers like you have the right to handle your own worker’s comp case, but make sure you understand what to do after a claim denial. The workers’ compensation appeals process is often more complicated than the initial claim. There are strict deadlines and filing requirements for your workers’ comp claim after a workplace accident. If your claim was denied, make sure you understand why and what you can do to make sure your injury is covered.

workers’ comp attorney is familiar with the state laws for workers’ compensation cases. A lawyer can help you through the claims process and represent you in a dispute or appeal. If your employer wrongly denied your claim, your attorney can take your case to court to fight for the benefits you deserve or negotiate a settlement.

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