Dealing with a Workers’ Compensation Claim Denial
When you are injured at work, your first course of action is typically to file a claim for workers’ compensation (after you have received medical care). If you are like many people, though, you may be surprised to have your seemingly legitimate claim denied. You have options, though, but you will need an experienced lawyer to guide you through the process.
Why Was Your Claim Denied?
The first thing you need to do is determine why your claim was rejected. For far too many people, the reason for denial was a failure to file the application within the required time period. Even though you may still be receiving medical attention and may not know the full extent of your injuries, you must still file your request for benefits within the period of time stated in the workers’ compensation laws, usually 30 days.
Another frequent occurrence—your employer disputes the claim. This can happen for a variety of reasons, including:
- Your employer’s assertion that the injury was not work-related
- Your employer’s belief that your injury is not as serious as you claim it is
- Your employer may claim that the type of injury is not covered by workers’ compensation (mental distress, for example)
The Appeals Process
Though the appeals process is different in every state, there are certain steps that you should always take. First, if you don’t have an attorney, now is the time to hire one. Your attorney may opt to contact your employer or the workers’ compensation insurance provider directly, to determine if there was a mistake in the paperwork or other technical problems with your claim that can easily be resolved.
If you are unable to resolve the matter by discussing it directly with your employer or the insurer, you will likely have to appeal your denial to an administrative law judge. A hearing will be set, and attorneys for both sides will present evidence regarding the claim. There are generally additional levels of appeal, should your claim be denied by the administrative law judge. Some states even allow you to file an action if court, if your administrative remedies are exhausted.
Contact Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP
At Barnard, Mezzanotte, Pinnie, Seelaus & Kraft LLP, we have fought for the rights of individuals throughout Delaware County since 1980. We offer a free initial consultation. To schedule an appointment, call us at 610-565-4055 or 302-594-4535 or contact us online.