Going through the workers’ compensation process can be a stressful time. There are many different moving parts, many of which are out of the realm of your control. You can only file a workers’ comp claim and submit it.
Maybe you feel at work and sustained an injury. Perhaps someone else’s negligence leads to the injury that you’re currently dealing with. Whatever happened, you need financial compensation to get your life back on track.
However, there are instances in which you find your workers’ comp denied. If that’s the case, then be sure to see below for an in-depth guide to your question “what if workers’ comp is denied?”
What to Do When Workers’ Comp Denied
There are many reasons why a workers’ compensation claim might be denied (more on that in a bit). However, finding out that your workers’ comp claim was denied can lead to a hopeless feeling.
The insurance provider would have you believe that there’s no further action that can be taken, but that’s not true. You still have a few tricks up your sleeve if this occurs!
Mainly, you’re now going to appeal the provider’s decision. Every time a claim gets denied, the provider is required to send a denial letter stating why they chose to deny the claim and what the deadline is for you to appeal.
Even if they don’t provide it in the letter, it’s a state law. Simply research your state’s policy on how long you have to appeal. See below for a couple of steps to follow during the appeal process.
Meet With Your Employer
It’s not always the big reasons that lead to a workers’ compensation denied claim. It might be a simple misunderstanding.
For example, you or your employer may have made a clerical mistake that leads to the denial such as misinformation or filing it incorrectly.
Because of that, it’s important to meet with your employer first. See if they have any information on why the claim was denied. Even if they don’t, they can provide you with contact info for their workers’ comp insurance carrier.
Hire a Lawyer
If it doesn’t seem to be a clerical issue that leads to the denial, then you’ll want to find an attorney to represent you.
Appealing an insurance carrier’s workers’ comp denial is a complicated process. It requires a lot of legal steps, most of which require an attorney to be present.
They can help provide you with a step by step guideline for you to follow. They’ll take this matter into their hands and see it through to the end. Your attorney can help you build your case by compounding evidence.
If you hire an experienced lawyer, then there’s nothing they haven’t seen. They can use their resources and network to construct a plan and help you get the compensation that you need.
Why Do Workers’ Comp Claims Get Denied?
Truth be told, many factors can lead to a workers’ compensation claim getting denied. It’s important to know what these are ahead of time so that you can avoid filing a claim that’s bound for failure.
See below for many reasons why your claim might get denied. Make sure none of them apply to your situation.
Influence of Drugs or Alcohol
There are many times in which a workplace incident could have been avoided if an employee was in the right state of mind.
If you were under the influence of alcohol or drugs, then you’re not legally allowed to make a workers’ comp claim.
You might be wondering “how would they find out?”. When you visit a doctor for a workplace injury (a necessary part of the process), your company may require you to be tested for alcohol or drugs in your system.
The Injury Didn’t Occur at Work
To receive workers’ compensation benefits, your injury has to have occurred while you were on the job. Even if the injury you sustained outside of work affects your ability to do your job, you’re not eligible for workers’ comp.
Many people try to take advantage of workers’ comp by claiming that an injury happened on the worksite when it actually occurred elsewhere. If found out, this constitutes a worker’s compensation fraud, a felony that could cost you up to 5 years in prison.
If your injury happened at work, then you have nothing to worry about. If it didn’t, then don’t try to make a workers’ comp case out of it, it won’t work.
You Didn’t File In Time
Believe it or not, there’s actually a time window on when you’re allowed to file for a workers’ compensation claim.
If you don’t file it within that period, then you risk losing the opportunity to get benefits and compensation for your injury. This also applies to medical conditions that stem from many years on the job.
Any time that you believe you’ve experienced a workplace injury, get with your employer right away and see what their provider’s deadline is for filing. Then hire a lawyer and file the workers’ comp claim as quickly (yet efficiently) as possible.
Was Your Workers’ Comp Denied? Take Action Today
Now that you’ve seen an in-depth guide on what to do if workers’ comp denied, be sure to use it to your advantage.
Start by hiring the right lawyer for the job. Find someone that’s experienced and specializes in workers’ compensation disputes.
Be sure to browse our website for more articles on workers’ compensation, as well as many other helpful topics that you’ll find interesting.
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