What to Do If My Workers’ Comp Claim Is Denied?

When you get hurt at work, it may keep you from getting back to the office right away. Many states have laws requiring your employer to compensate you following your injury. Employers often have some form of workers’ compensation insurance. They pull from that policy in these instances. But what if your workers’ comp claim gets denied?

Why Are Claims Denied?

There are plenty of reasons that your claim to workers’ compensation might get sent back to you. You should receive a denial letter explaining this. With the help of CA Workers’ Compensation Attorney, a Los Angeles workers’ comp attorney, we will walk you through the primary reasons, so you’ll have some idea of what to expect.

In most cases, workers’ comp claims get denied on the simple basis that they weren’t done on time. This can mean one of two things.

First, says FindLaw, your injury must get reported as soon as possible after it occurs. Second, you must file the claim within the timeframe given by the state. Neither one is a fun experience.

Another reason you could get denied is that your employer contests the claim. They might “claim the accident happened outside of work, was the result of horseplay, or some other disqualifying reason”.

Depending on your particular state, injuries related to stress may not receive compensation. According to FindLaw, California, for example, does mandate this coverage. Not every state will be this way, of course.

The final two reasons are somewhat related to each other. Your claim could get denied on the grounds that you did not receive medical treatment. Or, you get denied because they claim there isn’t enough proof it is work-related, says FindLaw.

As they go on to point out, “another medical exam and additional evidence may help your case.” This is why I say those last two dismissal grounds are in the same camp. Get the medical attention you need and report the case as soon as possible.

What Can I Do If My Claim Gets Denied?

So, let’s say your claim has gotten denied for one of the reasons given above, or even one that isn’t listed. There are ways you can fight back, as it were, to seek an appeal on your workers’ comp claim.

For starters, as Nolo says,”Don’t give up.” It is quite possible that the claim was first denied because of a clerical error. In other words, something went wrong with the paperwork.

Read your letter and find the exact reason given for your denial. If it isn’t a mistake that your claim has gotten denied, there are other things you can do.

This is what attorneys refer to as the appeals process. Every state has its own particular rules for this sort of thing. You will want to make sure you know your state’s specific law as it relates to workers’ comp and appeals.

Usually, “the first level of appeal will be at a hearing before an administrative law judge,” says Nolo. There, you will be able to offer your evidentiary documents. These might be medical documents or any other defense for your particular claim.

Keep in mind, though, that the hearing itself could happen via your state’s department of labor. It might also deal with the state’s workers’ compensation board. Outside of this, there exist even more appeals possibilities.

The administration level, though, will be the first one you need to get through. There is, of course, some hope that your case’s denial gets reversed right away! If it does not, though, don’t give up hope.

FindLaw and Nolo are both well-regarded sources of legal information and advice. They both suggest the help of an experienced attorney when dealing with your appeal.

According to FindLaw, “Accepting a denial of benefits can be financially devastating.” This is a fact. You do not want to give up at the first denial. In these cases, “you may want to meet with a workers’ comp lawyer.”

How to Pick a Workers’ Comp Attorney

This will seem to some as stating the obvious, but I have to say it anyway. Not all lawyers have the same skill set.You may think that any old attorney can get the job done, but this is not the case.

If you were having tax problems, you wouldn’t want a medical malpractice expert. The same is true of workers’ compensation lawsuits. You must, I repeat, must, find and pick a lawyer with years of experience and success in your specific area of need.

I have mentioned FindLaw and Nolo several times throughout this article. They are also a fantastic place to look when searching for an attorney. FindLaw’s catalogue is here. Nolo’s is here.

Again, if you are somehow denied your workers’ compensation and you feel this is wrong, do not give up hope. The right legal professional can guide you through the appeals process and, wit hany luck, get you a win.