Workers Compensation Lawyer
When a job-related injury occurs, worker’s compensation is meant to provide a financial safety net for employees to seek treatment. However, legitimate claims are often denied, and the process of acquiring the financial resources you are entitled to is tedious and confusing. If your worker’s compensation is denied, the first step is to pinpoint the reason for the denial.
There are many reasons why coverage is rejected, and unfortunately many are simple administrative mistakes. The Worker’s Compensation System is composed of very specific rules, unforgiving deadlines, and particular paperwork that must be taken into account. If any of these aspects are overlooked or improperly submitted, you are more likely to have your claim denied. Insurance companies are required to clearly state in their Notice of Denial which claims they are denying, and why they are denying them. Oftentimes if your claim is rejected simply because there is information missing, a quick call to the insurance office can amend these mistakes.
While laws and regulations vary in each state, some common situations where workers’ compensation claims are denied include:
- The Injury Wasn’t Reported in Time
You must report your injury as soon as reasonably possible in order to receive benefits. Many states require that your employer is formally notified within 30 days, although some accept notifications after if the employer was informed verbally.
- The Report Wasn’t Filed in Time
Unfortunately many people do not understand that reporting and filing a claim are different processes. The Statute of Limitations period is the formal deadline for filing your worker’s compensation claim. If it is missed, the insurance company can rightfully reject your claim.
- The Injury Did Not Occur on the Job Site
To receive workers’ compensation, you must be injured while performing your duties on the job site. If the injury happens before or after work, or even on your lunch break, your claim will be rejected.
- You Were Incoherent When Injured
If you were injured and any sort of proof arises that you were under the influence of drugs or alcohol, then your worker’s compensation will most certainly be denied. Furthermore, if proof is found that you were roughhousing or being careless on the clock, your claim will also be rejected.
- Insurance Will Not Cover Your Condition
The conditions covered by each state can widely vary. Some states don’t cover strains and sprains, even if you have to miss a few days of work because of them. Many states also initially deny mental health claims like PTSD. To receive coverage, you have to link your mental health issue to a specific work-related event.
Appealing Your Denial
Having your workers’ compensation denied for these reasons or any other is disheartening. If you have any evidence that your claim was fraudulently denied, or if you are at the fault of an administrative error, you can request a complaint form and your case will be considered again.
Reopening Your Claim
If new evidence is found that proves your work-related injury, or if your current injury worsens, you may benefit from reopening your workers’ compensation claim. There are time limitations for reopening a claim that of course, vary from state to state. Some cases are also considered finalized when you receive insurance and a formal release is signed.
Requesting an Administrative Hearing
If you find that the insurance company is being lackadaisical in processing your claim, or if you disagree with their decisions entirely, requesting an administrative hearing is a logical next step. Rather than working with your employer or insurance company, your case will be presented in front of an administrative judge, so you must be ready to argue your situation and provide evidence.
Ultimately, whatever step you decide to take will be best guided by a lawyer, like a workers compensation lawyer in Milwaukee, WI. Although the process can be timely and expensive, a workers’ compensation lawyer that you trust can help you acquire the benefits you are entitled to, and save you out of pocket medical payments in the long run.
Thanks to our friends and contributors from Hickey & Turim for their insight into workers’ compensation.