The workers’ compensation insurance system was specifically designed to allow injured employees to recover financial compensation for their medical bills without clogging up the courts with lawsuits. The intentions were good, but unfortunately, many valid claims get unfairly denied – roughly 7%. If you’ve filed for workers’ compensation and have been denied, there are several ways to handle your denial.
1. Talk to a workers’ comp attorney
Talking to a lawyer should be your first step after getting your claim denied. There’s no better way to figure out what happened and whether or not the decision was solid than by discussing your situation with an attorney.
Workers’ comp attorneys know how the system is supposed to work, and they can spot unfair denials by reviewing your case. Lawyers understand the intricacies of workers’ comp laws, and will tell you if you don’t have a valid claim, or if there is something uncertain that the insurance company may have used to deny your claim.
An attorney will tell you if your case was rightfully denied. For example, if you didn’t report your injury to your employer within the required time frame, the insurance company might use that to try to prove you weren’t really injured. Other valid reasons for denials include:
· The injury was caused by roughhousing or horseplay
· You were intoxicated by drugs or alcohol when you were injured
· You never sought medical treatment or denied treatment
· Your claim wasn’t filed on time (this can be difficult when dealing with injuries that occur over time, like carpal tunnel)
· Your injury was caused by a pre-existing condition
If any of the above apply, you probably can’t proceed with an appeal or lawsuit. However, it’s best to contact an attorney to get a definitive answer from an expert.
2. File an appeal
In most cases, even if you want to file a lawsuit against your employer, you will need to appeal your workers’ comp denial first. You can file an appeal on your own, or with the help of a lawyer. It’s actually better to have a lawyer file your appeal because it will give you a better chance at success.
As a legal professional, they’ll make sure to raise convincing points, and provide new evidence if applicable. Plus, when insurance companies process appeals from attorneys, they know they can’t get away with bad faith decisions or sending you a lowball offer if your appeal is won.
3. Talk to your employer
While you shouldn’t jump to conclusions, there’s a chance your employer had something to do with your claim being denied. Your employer can dispute your claim for a number of reasons, and if that’s what happened, talking with them might help. For example, they may have told the insurance company you weren’t at work when you were injured, or that you submitted incorrect case details.
Sometimes employers try to avoid successful claims because they’re afraid it will make their premiums rise. It’s not fair, but it does happen. It’s always best to talk to a lawyer first, but if you can talk to your employer without getting heated, you may just want to ask them what happened from their side of the story. If they tell you something that contradicts the truth, simply thank them for their time and go straight to a lawyer.
4. File a lawsuit
When your original claim and appeal are both denied, your last resort is to file a lawsuit against your employer. If you can prove that your employer wrongly denied your claim, you can sue them. Just make sure you hire a workers’ comp attorney and don’t try to handle your own case. Leave it to an expert and you’ll be more likely to get a favorable settlement.
Don’t waste time – act now
Whatever you decide to do, it’s crucial to act fast. Most workers’ comp claims don’t get paid out until the injured party reaches a state designated as “maximum medical improvement” (MMI), which is another way of saying that a doctor has determined the person has recovered. Some claims get paid out before this point, but you won’t know ahead of time. Depending on your injuries, you may not reach MMI for six months to a year.
The longer you wait to fight your denial, the longer it will take to get compensated, whether it’s through workers’ comp or a lawsuit. Don’t waste any time taking action. Talk to an attorney as soon as possible to learn about your options.