Steps to Take After a Workers’ Comp Claim Denial
Updated: Nov 6, 2021
Being injured on the job is a stressful situation. Finding out your workers’ compensation claim has been denied compounds stress and adds worry, especially if you are unsure about what to do next. It’s no secret that insurance companies look for even the slightest detail that can give them a reason to deny your workers’ compensation claim. Be prepared and arm yourself with these facts about the workers’ compensation appeals process.
Understand Why Your Claim Was Denied
The very first step in the appeals process is to understand why your workers’ compensation claim was denied. Your denial letter should clearly state the reason. If you believe the reason for the denial is unjustified, you have the right to appeal the decision. Should you be confused or not understand the reason for the denial, an experienced workers’ compensation attorney can explain it to you as well as advise you on what paperwork you will need to file with your appeal, such as medical documents and other proof.
Common Causes For Claim Denials
It’s not uncommon for insurance companies to deny workers' compensation claims for even the most seemingly minuscule reason. This is why it’s especially important to pay attention to detail when filing an appeal. Making mistakes can cost you a favorable decision so it’s important to know these common reasons for denial:
The work-related injury was not reported in time
The claim was not submitted within filing deadlines
Your injury is not eligible for workers’ compensation benefits
You did not obtain medical treatment for your work-related injury
There is a lack of evidence that your injury happened on the job or was work-related
Your employer is disputing the claim
Appealing the Decision
The process of actually submitting an appeal will vary from state to state unless you are a federal employee. With that being said, there are certain things that all claimants should do when seeking an appeal.
Contact the insurer directly to find out why your claim was denied. The solution may be as simple as submitting a specific document.
Ask the insurer to reconsider its decision.
File a formal appeal with the appropriate administrative agency within the appropriate timeframe.
Retain the representation of a skilled workers' compensation attorney to handle the appeals process.
Appealing a workers’ compensation decision on your own could be extremely stressful, especially when you are trying to work on healing from your injury. Individuals who take on an appeal are expected to know workers’ compensation laws, as the workers’ compensation board is not permitted to give any advice to those without an attorney.
Navigating through workers’ compensation laws can present many challenges along the way and not knowing how to overcome these obstacles could be detrimental to your case. A skilled workers’ compensation attorney will know what to look for when reviewing your case so they can create the best plan of action to increase your chances of claim approval.
If you need assistance in filing a workers’ compensation claim or an appeal, we can help. We can even help for general personal injury cases. Contact Spellen Law, LLC at (205) 820-94745 today to get started. Let our team of attorneys help you get the workers’ compensation benefits that you deserve.