Denial of Workers' Comp Benefits and Appeals

A work-related injury can take you out of work for months. Under state workers’ compensation laws, employees get medical and wage benefits after a workplace injury. But 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 not approved. However, you only have a limited time to request a hearing. Each state has different workers’ comp laws and deadlines. Find an experienced workers’ compensation lawyer in your area to have your claim approved.

Understanding the Workers’ Compensation Process

Most states require employers to provide workers’ compensation insurance coverage for employees. Workers’ compensation provides medical care to cover workplace injuries. Workers’ comp also provides income replacement when you’re unable to work.

If you can’t return to work after medical treatment, you can get Social Security Disability benefits. There are partial and total disability benefits to help workers who can no longer return to the work they did before the accident or occupational injury.

After an on-the-job injury, injured workers 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 pay for 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.

Common Reasons for Denied Workers’ Comp Claims

If the workers’ compensation insurance provider doesn’t believe the injury happened on the job, they can 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 they denied your claim. It also has to inform you of your rights to appeal.

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

• The injuries don’t match the alleged accident, or they relate to a preexisting condition
• You didn’t 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 of your claim, you can file an appeal and request a hearing.

Steps To Take After a Denial

Workers’ compensation claim disputes have a time limit. 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. A lawyer can act quickly to make sure you file your appeal in time.

Resolving 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.

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 medical expenses.

Benefits of a Lawyer for a Worker’s Comp Appeal

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 more complicated than the initial claim. There are strict deadlines and filing requirements for your workers’ comp appeal. If your claim was denied, make sure you understand why and what you can do to make sure your injury claim is covered.

A workers’ comp attorney is familiar with state laws for workers’ compensation cases. An experienced lawyer can help you through the claims process and represent you in a dispute or appeal. Most workers’ comp and personal injury lawyers offer a free consultation. So, you won’t have to pay anything for a case evaluation. If your employer wrongly denied your claim, contact a workers’ compensation lawyer for legal advice.