Denied Workers’ Comp Claims

Denied Workers’ Comp Claims

Denied Workers’ Comp Claims

After an accident at work results in injuries or a medical diagnosis for a work-related illness, you can file a claim for compensation and benefits.

While you would prefer a quick approval, it will take a complicated claims process. For this reason, work with a work workers' compensation attorney who can ensure your claim proceeds correctly and get you on the path to compensation.

Continue reading to learn more about workers’ compensation, the claims process, and claim denials.

Understanding Workers’ Compensation

Most employers must carry workers’ compensation insurance to protect workers with work-related injuries or medical diagnoses for conditions developed at work.

Workers’ comp is a no-fault insurance. This means that, in exchange for receiving benefits and compensation under this insurance, your employer receives protection against any legal action you may have had the chance to take otherwise.

Under the law, only certain employees qualify for coverage, and specific injuries and illnesses count toward receiving benefits.

Workers Eligible for Coverage Under Workers’ Comp

Generally, every business that has employees must carry workers’ compensation insurance for the benefit of said employees. Only certain exceptions apply, depending on state and federal law.

When employers fail to carry workers’ compensation insurance, they leave themselves open to penalties, including fines and imprisonment. In addition, employers may need to pay claims out of pocket.

Most employees, even part-time and seasonal employees, qualify for workers’ comp coverage. However, interns, contractors, and volunteers do not qualify for coverage.

Your lawyer can determine whether you have coverage under workers’ compensation based on your type of employment. Should you have protection and meet eligibility requirements, you have the right to file a claim for compensation.

Injuries Covered by Workers’ Compensation

To receive workers’ compensation benefits, you must have suffered an injury at work or received a medical diagnosis for a condition related to your occupation.

Usually, most injuries that occur while on the job will have coverage under workers’ comp insurance.

However, under certain conditions, an injury may not qualify you for coverage, including:

  • Self-inflicted injuries
  • Injuries caused by fighting
  • Injuries caused while violating company policies

If you suffer injuries at work, seek medical care right away and report your injury to your employer. Then, discuss your situation with an attorney for personalized guidance.

Benefits Workers’ Comp Insurance Can Provide

Workers’ compensation insurance can provide much-needed benefits for employees whose lives and ability to work are impacted by their injury or condition.

Some of the most significant benefits include income replacement and medical cost coverage. You can also receive additional benefits if you have a disability, including partial disabilities and total disabilities, whether permanent or temporary. 

Finally, workers’ compensation can provide death benefits when an employee dies because of their work-related injuries or condition. These benefits include funeral and burial costs and income replacement.

To learn more about the benefits you deserve under workers’ comp for your specific situation, speak to a work injury attorney immediately.

Getting Workers’ Compensation Benefits

Workers’ compensation benefits don’t come to you automatically. Instead, you must take certain steps to protect your rights and apply for benefits and compensation.

If You’re Injured While on the Job

If you experience an accident at work and suffer an injury, prioritize your health. Seek medical attention right away. If your injuries are serious enough, call 911 for emergency medical care. Otherwise, visit an emergency room, urgent care, or your primary care physician for treatment.

After you’ve taken care of your medical needs, you must report your accident and injury to your employer or supervisor. State law dictates how long you have to notify your employer, which can be 30 to 90 days after suffering your injury.

Report your injury to your employer, as it gives them notice to contact their insurer.

Depending on your state’s procedures, your employer may file the claim on your behalf, or you may have to file your claim yourself.

Typically, the requirements are the same for a work-related condition. You’ll usually receive your diagnosis either because you sought medical care because something was wrong or you unexpectedly received your diagnosis.

After you’ve received your diagnosis, you also need to notify your employer or supervisor. After the fact, your employer must start the process on their end with their insurer.

Filing a Workers’ Compensation Claim

Familiarizing yourself with your state’s procedure for filing a workers’ compensation claim is important. An attorney who knows how the process works and how long you have to file can ensure the success of your claim.

When your employer files necessary paperwork on your behalf, check the status of your claim periodically. If they fail to do so, you can step in and submit your own claim.

In some states, however, you must file your claim independently after notifying your employer. Still, checking in and staying on top of your claim helps.

Seek guidance from a skilled local work injury attorney for the stressful and confusing workers’ comp process.

How Long Does It Take to Receive an Answer and Start Receiving Benefits?

Every state is different, but generally, expect to receive a response within two to three weeks regarding your claim. Some states have additional requirements to meet before you receive a decision, including visiting an approved doctor for a physical examination.

If workers’ comp approves your claim, you’ll soon receive your benefits. Depending on your state, you should receive your checks within weeks of filing your claim.

However, some insurance carriers have longer to process payments by law. If your payments take too long, you may receive interest on the delayed payments.

Getting a Workers’ Comp Claim Denial

When you file a workers’ compensation claim, the last thing you want to receive is a denial letter. However, denials happen frequently, especially because workers’ compensation insurance companies are difficult to deal with.

Insurance companies have no qualms about denying compensation claims. The most minor mishap or mistake can cause a denial.

A denial doesn’t mean you won’t ever receive the benefits you deserve. You’ll simply need to continue pursuing compensation and work diligently toward an approval.

Common Reasons Why Workers’ Compensation Claims Get Denied

Workers’ comp can deny your claim for many reasons. The following are just some common reasons you may receive a claim denial.

Failing to Notify Your Employer Within the Required Time

After suffering a work-related injury or receiving a medical diagnosis, you only have a short time to notify your employer. If you report your injury or illness to your employer after the time has expired or fail to notify your employer at all, workers’ comp can deny your claim.

Without reporting your injury or condition to your employer, they won’t have the opportunity to notify their insurer. Additionally, failing to report can cause your employer or their insurance company to claim you weren’t actually hurt because if you suffered an injury, you should have reported it sooner.

Notifying your employer may seem like a small task, but it can greatly impact your claim.

Waiting Too Long to File a Workers’ Comp Claim 

Failing to report your accident to your employer on time can affect how long it takes to file your workers’ comp claim, especially when your employer must take steps to file documentation with their insurer.

Still, even if you have to file your own claim, waiting too long can negatively impact your chances of receiving benefits and compensation. Every state has a statute of limitations for filing workers’ comp claims, which is usually one to two years.

Workers’ compensation insurance only covers injuries and illnesses that originated from your occupation. While you may suffer an injury away from work, any injury that’s not sustained in a work-related accident or while performing tasks inside the scope of your employment will not count for workers’ comp benefits. 

Filing a Claim for a Pre-Existing Condition

Along the same lines, workers’ compensation doesn’t cover pre-existing conditions. A pre-existing condition is a medical condition you suffered before starting your job or outside of any work-related activities.

Under certain circumstances, you may have the opportunity to receive benefits for conditions that are made worse by your occupation. This typically requires extensive medical documentation to prove your condition existed but your job considerably worsened it.

Failing to Get Medical Treatment 

Failing to get any medical attention is one of the quickest ways to get a denial from workers’ compensation.

When you don’t get medical treatment, this can communicate to the insurance company that your injuries or condition were not that serious to begin with. 

Additionally, and most importantly, getting care allows you to build your medical records. Failing to see a physician and get treatment means you won’t have any medical records for the insurance company to review. And when there are no records, no official information is available concerning your injuries.

Not only is it important to seek medical care, but it’s also critical to follow through with your treatment plan. As you continue with your treatment and attend follow-up visits, your medical records continue to grow as your provider documents your progress.

Missing Items on Your Workers’ Comp Claim

Filing a workers’ compensation claim involves plenty of information and documentation. If you miss something, the insurance company can use that as a basis for denial.

This is one of the reasons why you want to work with a work injury lawyer. An attorney can help ensure your claim includes every piece of information and documentation necessary to get your approval.

Options After Receiving a Workers’ Comp Claim Denial

You may have options to pursue a better outcome after getting a denial on your workers’ compensation claim.

In most cases, you can petition your state’s division of workers’ compensation to request a hearing. The judge will hear your case and review any evidence presented during the hearing. After your hearing, you’ll get a ruling on your claim.

You can appeal the decision in your local appellate court if the ruling is not in your favor.

A claim denial is not the end, and you don’t have to accept it, but file your petitions and appeals timely to preserve your right to fight toward reversing your denial.

When to Hire a Lawyer for Assistance With Your Claim

Simply put, you should hire an attorney as soon as possible after suffering an injury at work.

Filing a workers’ compensation claim and dealing with the process can overwhelm you, especially when dealing with your treatment and recovery. When you have an attorney, they can handle everything related to your claim to get you the approval you deserve.

If you don’t hire a lawyer right away, it’s not too late. You can still hire an attorney after you receive your claim denial. Your lawyer can review your situation and determine how to proceed with an appeal.

Hiring a work injury attorney can give you peace of mind during a challenging time.

It Is Possible to Receive an Approval After a Denial

Richard Reinartz, Workers' Compensation Attorney
Richard Reinartz, Workers' Compensation Attorney

If your workers’ compensation claim gets denied, do not worry. While a claim denial isn’t ideal, it doesn’t mean you’ll never get the benefits and compensation you deserve.

When you get your denial letter, speak with a work injury attorney immediately for qualified assistance and support. They can review the reasons for the denial and develop a strategy to prove your eligibility for benefits.

The workers’ compensation system is more complex than most people think, but you do not have to navigate the claim process alone. A personal injury attorney is ready to help you.

Schedule a Free Initial Consultation Today!