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How to Handle a Denial of Workers’ Compensation Benefits

'Maggio Law

There are many situations where a person might be injured on the job or develop a medical condition while working. This could include everything from lung disease because they were exposed to toxic chemicals as well as a repetitive strain injury and more. In these situations, workers believe they will qualify for workers’ compensation benefits. It is possible for mistakes to happen. Individuals have been wrongly denied workers’ compensation benefits.

It is possible for an employer’s insurance company or even an employer to find a reason to deny workers’ compensation claims.

There are some common reasons claims are denied.

  • Missed Deadline. A worker should report their illness or injury immediately to their employer. The next step is to file a workers’ compensation claim with the designated state agency. Each state has a specific time limit for filing claims. Should someone miss this deadline, their claim is usually denied.
  • Claim Filed After Leaving The Job. It is common for insurance companies to deny a workers’ compensation claim after the employee was let go, laid off or fired. It is possible for a state to have special regulations covering claims filed after a person leaves their job.
  • Employer Disputes Injury. It is common for employers to challenge a worker’s claim they were injured on the job. An employer may also claim a worker’s injury was a result of misconduct and not caused by exposure or an accident while working.
  • Doesn’t Meet State Guidelines. It is possible for the laws of a state to have specific restrictions concerning workers’ compensation claims. Some will not approve claims involving long-term emotional stress at the workplace and more. A person’s injuries may not be considered serious enough to meet the standards for filing a workers’ compensation claim.
  • No Medical Treatment. In most situations, a person must have medical treatment to justify an approval for workers’ compensation benefits.
  • Pre-existing Condition. This is when an injury on the job is believed to have been caused by a preexisting condition and had nothing to do with performing tasks at work.

Denial Letter

It is always possible to appeal the denial of a workers’ compensation claim. The first step is to carefully read the denial letter. If it is appears the denial was based on a mistake with paperwork or something like it, the situation may be fixed by contacting a claims adjuster and working to fix the problem. This will only be successful if an insurance company and employer are willing to admit they made a mistake.

Appeal Process

A denial letter should include information about a state’s appeal process. The initial appeal will often involve a hearing before an administrative law judge. This is where a person can present evidence to support their claim. Each state has its own type of appeals that follow a hearing before an administrative law judge.

Going through all of a state’s workers’ compensation claim appeals process can be very complicated. It is something that will require the legal guidance of an attorney experienced at handling workers’ compensation claims. They will know how to analyze a case and what is required to get a workers’ compensation claim approval after an initial denial.

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