Having your workers’ compensation claim denied can feel like a huge blow, but don’t give up just yet. Understanding the reasons behind denials and knowing how to navigate the appeals process can shift the situation in your favor.
Let’s take a look at what you can do to challenge your denial and get the benefits you deserve.
- Talk to a workers’ comp attorney
Nobody will help you fight a denial like a workers’ compensation lawyer. They know the system inside and out and are familiar with all the shady tricks used to deny legitimate claims. However, if you don’t have a claim, they’ll tell you so you don’t waste your time.
When you hire an attorney, they’ll review your documents and tell you if your denial was unfair. If that’s the case, they’ll fight your denied workers’ compensation claim to help you get paid.
- Understand the reasons for your denial
When you get your denial letter, it’s crucial to read through the entire letter to identify the reason(s) your claim was rejected. Understanding why you were denied is necessary for building a strong appeal argument. For example, if you were denied for a lack of medical evidence, you’ll need to get additional documentation from your medical provider when submitting your appeal. If your claim was denied because of a technical error, like a misspelled name or incorrect date, the claims adjuster should be able to fix it right away and resubmit your claim.
Some denials can be appealed, but some can’t. For example, if you missed the deadline to file your initial claim, you’re probably out of luck. Deadlines are strictly enforced. That’s why it’s imperative to file your appeal within the time frame specified by state law. If you don’t understand your denial, don’t hesitate to contact the person in charge of your case to ask for clarification.
3 Address the reason(s) for your denial
When creating an appeal, you’ll want to address the specific reasons your claim was denied. Workers’ comp claims are commonly denied for the following reasons:
- An employer disputes the injury. Sometimes employers dispute whether the injury took place at work. To fight this, you’ll need to gather witness statements and anything else you can find to prove your injury occurred at work.
- Pre-existing conditions. Sometimes a pre-existing condition makes it hard to determine if a reported injury is new. Some workplace injuries make pre-existing conditions worse, but to prove this, you’ll need medical records demonstrating your condition was stable before your workplace accident occurred.
- Lack of medical evidence. You can submit new medical records with your appeal if you didn’t provide enough documentation with your initial claim.
- Non-compliance with treatment protocols. Not following your doctor’s prescribed treatment makes it look like you aren’t injured and that can be hard to fight.
- Build your case with more evidence
It helps to have a lawyer build your appeal, especially since the denial rate has risen in recent years, so if you’re working alone, take a systematic approach to building your case. Here’s what you’ll need to gather:
- Detailed medical records. If there are any medical records you left out of your initial claim, be sure to include them in your appeal. Since you can only provide new evidence with an appeal, it’s the perfect opportunity to include anything you overlooked. Submit everything related to your injury, even if you don’t think it’s relevant. Let the insurance adjuster make that call.
- Request a copy of your accident report. Hopefully you reported the accident to your employer. Make sure you get a copy and submit it with your appeal if it wasn’t included in your original claim.
- Gather additional witnesses. If there’s a chance you overlooked a witness or two, get statements from them to include with your appeal.
- Get security footage. If your accident would have been recorded by your employer’s security camera, make a formal request for a copy as soon as possible.
- Submit your personal documentation. If you documented your injury, pain levels, and challenges arising from your accident before filing your claim, that information could be valuable.
- Go through all the motions
Once you have all the additional evidence and documentation you’ll be submitting with your appeal, you’ll need to file your appeal promptly. Unlike an initial claim, appeal deadlines are tight.
Don’t let a rejection stop you from appealing
A denied workers’ comp claim isn’t necessarily the end. By understanding why you were denied and building a strong appeal, you have a chance to turn it around and get the compensation you deserve.