In the aftermath of a work-related injury, it can be discouraging to learn that your initial claim to receive workers’ compensation benefits has been denied. Fortunately, there are structures in place that allow those whose claims have been denied to take legal action. By working with an experienced lawyer through the appeal denial process, you can be confident that you are taking all the right steps toward being justly compensated.
Workers’ compensation is designed to be a system of benefits provided to employees who experience injuries or diseases directly related to their work. If you are not able to receive these benefits, it is important to understand why your claim was denied and what you should do next. Your denial letter may inform you of the reason your claim was rejected. Should you believe the denial to be unjustified, it is your right to appeal the decision.
Reasons a Claim May Be Denied
Claim denial may come from one or more sources. An employer, or their insurance company, can contest a claim that has been made by an employee. Once you have reported the injury, your employer will begin insurance processes, file accident reports, and make the decision to accept or deny your claim. Most employers are supported by expert legal teams who may scrutinize and contest details regarding your injury, medical treatment, or wages. Staying in communication with your lawyer can help to give you assurance that you are following the proper procedures.
A claim may be rejected on the grounds that it does not meet the legal requirements for eligibility as outlined by state law. Basic requirements for eligibility include holding employment with the employer, sustaining an injury related to work, and reporting the injury and filing your claim within specified deadlines.
Various reasons may be cited in order to deny a claim, from technicalities and missed deadlines to lack of proof that the injury occurred at all. An employer, insurance company, or workers’ compensation commissioner can fully or partially deny a workers’ compensation claim for benefits. The following are a few examples of reasons a claim may be denied:
- Sufficient proof that the injury or disease was work-related was not provided.
- Deadlines for reporting injuries or filing claims were not met.
- The extent or permanence of the injury was less significant than the injured party claimed.
- The medical treatments received by the injured party were not necessary.
- A mistake was made on a form, or a procedural error occurred during the process.
- The injured party was under the influence of drugs or alcohol at the time of the accident.
Appealing a Denied Claim
Because of the complex nature of workers’ compensation law, a reliable attorney will work closely and diligently alongside you through the appeal denial process. This should include meeting with you to thoroughly discuss the case, negotiating with insurance companies, obtaining and analyzing relevant documentation such as medical records and wage history, and advocating on your behalf before the Workers’ Compensation Commission. The main steps of the appeal denial process are:
- Request a Hearing. After completing and submitting an Issues Form to your employer, your employer’s insurance company, and the Workers’ Compensation Commission, you will receive a hearing date. You and your lawyer will appear before a commissioner, who will consider evidence and determine the appropriate level of benefit you will be awarded.
- Present Evidence. An essential aspect of the appeal is your ability to provide evidence which can answer questions raised against the legitimacy of your claim. It is important to keep track of your documents, maintain accurate records, attend all scheduled medical appointments, and adhere to your treatment schedule. As your advocate in this process, your lawyer can use this information to help the commissioner make appropriate decisions as to the amount and type of benefit you will receive.
- Request a Rehearing. In the event that you are unsatisfied with the commissioner’s initial decision, you and your lawyer may have the opportunity to request a rehearing. A rehearing may be of particular importance if a legal error has occurred, or if new evidence relevant to your case becomes available.
- File a Court Appeal. Within 30 days of the date of your rehearing or the original decision, you may choose to file a court appeal. In this situation, you and your legal representative will be given the chance to present evidence before a Circuit Court and contest the decision made by the Workers’ Compensation Commission.
Throughout the appeals process, it is always a good idea to stay closely involved with the proceedings. Attentiveness to your case and good communication with your lawyer will increase your ability to receive your workers’ compensation benefits.
Belsky, Weinberg & Horowitz, LLC Is Here for You
If you have suffered a work-related injury, your main concern is recovery. We firmly believe that the legal process should not interfere with your right to focus on your well being. Our team at Belsky, Weinberg & Horowitz, LLC has a record of accomplishment in advocating for injured workers and handling disputes between employees, employers, and insurance companies. Backed by a foundation of legal expertise, we are ready to fight on your behalf and support you as you seek to regain health after injury. Reach out to our firm today so we can help you receive proper compensation.