How a Lawyer Will Help You Fight a Denied Workers Compensation Claim

Written by Moli Mishra, In Law, Published On

September 25, 2024

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A workplace injury can be a traumatic experience, particularly if your workers’ compensation claim is rejected. For injured workers asking for reimbursement for their medical costs and lost income, it is essential to understand the grounds for the refusal and be familiar with the case-appealing procedure.

Working with an experienced attorney can significantly increase the likelihood of successfully overturning a refusal. This blog post will help you learn more about a denied workers’ compensation claim, the exact procedure, and all the essential details mentioned at your disposal.

What are Workers’ Compensation Claims?

Workers’ compensation aims to help injured employees by paying for their medical expenses and a portion of their missed income. Claims, however, may be rejected for many reasons, such as missing deadlines, an absence of supporting medical documentation, or claims that the injury did not happen while the employee was employed. It is crucial to realize that a denial does not mean the end of the process; there are still ways to appeal the decision.

Denial Reasons or Grounds

Claims denials can happen for several frequent reasons:

Failure to Report: Denial may result if an injury is not reported to an employer in the allotted period. Injuries must be reported as soon as possible in most states, usually within 30 to 90 days.

Inadequate Medical Evidence: Inadequate records on the injury or how it affects one’s capacity for employment can also affect the decision. Insurance companies frequently want reports and thorough medical data from treating physicians.

Pre-Existing Conditions: If an employer claims the injury was caused by a pre-existing condition rather than an occurrence at work, the judge might deny your case. However, benefits can still be available if work-related injuries worsen an underlying condition.

Misclassification of Job Status: Employers can mistakenly identify certain workers as independent contractors rather than employees, which may impact the workers’ compensation payments that they are eligible to receive.

The Importance of An Experienced Lawyer

Having a workers’ compensation lawyer on your side might make a big difference if your claim is refused. Here are a few reasons why having legal counsel might be beneficial:

Examining the Refusal: A lawyer will discuss the letter of refusal and evaluate the particular justifications offered by the insurance provider. Understanding these reasons is essential to devising a successful appeal plan.

Proof Collection: An experienced lawyer will help to gather any required proof, such as witness statements, medical records, and any relevant paperwork that backs up the claim. This proof is essential to show that the accident happened while the employee was working and is eligible for benefits.

Appealing a refused claim: Some stringent timelines and steps must be taken to appeal a denied claim. Processing delays can be minimized by having a lawyer ensure all paperwork is completed appropriately and submitted on time.

Representation in Hearings: Legal counsel can be beneficial if an appeal results in a hearing before an administrative law judge or workers’ compensation board. If required, a lawyer will cross-examine witnesses, presenting information and making an argument on behalf of the injured worker.

Settlement Negotiations: Before going to court, reaching an agreement with the insurance provider in some circumstances could be possible. A skilled lawyer can fight for just compensation, considering the injury’s extent and how it will affect future earning potential.