As many Mississippians who have been injured at work already know, workers’ compensation is a no-fault system that provides for medical treatment and lost wages in the event of a work-related illness or injury.
Essentially, this means that regardless of whose “fault” the injury is or what caused the injury, a worker should be entitled to benefits created under the Mississippi Workers’ Compensation Commission’s statutory framework.
Seems simple and straightforward enough, right? Well, it isn’t always that easy. Oftentimes, our workers’ compensation clients come to our office wondering why their claim was denied.
Having your workers’ compensation claim denied following a work accident can feel like adding insult to injury. However, the story doesn’t have to end there—you have still have options even if your claim is denied.
Keep reading to learn everything you need to know about denied workers’ compensation claims in Mississippi.
Reasons Your Claim May Be Denied
The following are a few common reasons for your claim to be denied:
- You are not a covered employee, which can mean any of the following:
- Your employer is not required to have workers’ compensation insurance as a result of too few employees;
- You were not actually employed at the time of the injury;
- You are an independent contractor not under the control of the alleged employer; or
- Some other similar instance
- You or your employer failed to submit the claim on time
- Your employer claims the injury was preexisting or occurred outside the employer-employee relationship
- Your employer raises the defense that you were intoxicated at the time the injury occurred
- Your employer raises the defense that you intentionally self-inflicted the injury to be taken off of work and receive benefits
- Your application for benefits was either incomplete or did not include all the information needed in order to come to a decision
- The doctor or other medical professional who treated you provided incomplete or unsupportive notes
- You were either let go, laid off, or fired from your position
- You did not receive medical care for your illness or injury
- It is believed that your pre-existing condition caused your on-the-job injury and it had nothing to do with performing tasks at work
This list is not meant to be exhaustive; there are other grounds for employers and insurance companies to deny claims. However, what this list does show is that it is not always as easy as a claimant alleging an injury and automatically receiving benefits.
Sometimes claims get denied, but just because a claim has been denied, it does not mean that the claim will always be denied and never admitted. There are countless examples of our firm successfully working with insurance attorneys and adjusters to get our clients’ claims admitted and for them to receive workers’ compensation benefits.
Not All Workers Qualify for Benefits
Most Mississippi employees are eligible for workers’ compensation benefits under the law. However, there are exceptions that can make certain employees ineligible. The following are some examples of instances in which employees may not be covered by workers’ compensation benefits:
- Your employer regularly employs less than five people
- You work for a nonprofit organization
- You already have coverage under Federal workers’ compensation
- You’re an independent contractor (unless you worked for an uninsured subcontractor—in which case you may be covered)
- You’re a domestic or farm labor employee
Your Illness or Injury Should Be Covered
As long as your injury stems from the course and scope of your employment, you should qualify for benefits under Mississippi’s workers’ compensation program.
Your Claim May Be Denied in Bad Faith
If your workers’ compensation claim is denied and the reasons for the denial are not based on the law, you may have grounds for a lawsuit against your employer. A lawsuit of this nature can involve both compensatory and punitive damages.
Determining whether the decision was made in bath faith will require the help of an experienced Mississippi workers’ compensation attorney.
The Mississippi Workers’ Compensation Appeals Process
In order to submit an appeal for a denied workers’ compensation claim, you’ll need to follow the steps outlined below:
#1 - File a Petition
You’ll need to file a Petition to Controvert (Form B-5,11) with the Mississippi Workers’ Compensation Commission in order to begin your appeal. Include the original as well as three additional copies.
Keep in mind that there are strict deadlines for filing a petition—you’ll need to file within the first two years of the date of your injury.
#2 - Hearing
It’s common for Mississippi workers’ compensation cases to be settled through informal negotiations with the insurance company. However, if you cannot resolve the dispute, you’ll have an administrative hearing in front of a workers’ compensation judge.
Prior to the hearing, both parties will partake in a legal process referred to as “discovery.” This is an opportunity for you and the insurance company to do the following:
- Exchange information
- Question witnesses
- Gather evidence in support of your case
Once this process has concluded, which typically takes a few months, your case will be scheduled for a hearing. You and the insurance company must offer a prehearing statement, which will outline the concerns in dispute as well as the evidence that will be presented at the hearing.
Both parties will have the opportunity to do the following at the hearing:
- Submit documents;
- Present witness testimony; and
- Provide legal arguments
The evidence provided will be reviewed by the judge who will then mail a written decision once the hearing has concluded.
#3 - Continued Appeals
If you’re displeased with the judge’s decision, you may file an appeal to the Full Commission. In order to do this, you’ll need to file a petition for review within 20 days of the judge’s order.
It is uncommon for the Full Commission to decide to hold another hearing, but they may do so if requested. Additionally, you and the other party may submit written briefs including legal arguments that support your positions. A written decision will be mailed to both parties by the Full Commission.
It is possible to appeal through the state court system if you are dissatisfied with the Full Commission’s decision. You’ll need to file an appeal with the Workers’ Compensation Commission within 30 days. Then, the Commission will send your case’s record to the Mississippi Supreme Court for review.
If you believe that your claim received an unjust denial, we may be able to help you obtain the compensation you deserve. Our attorneys here at 'MAGGIO LAW are highly skilled in this area of the law and have helped many other people in similar situations obtain the benefits they needed when they needed them most. Let us see if we can help you, too. Don’t delay—contact our office with your questions right away.
Contact our attorneys at 'MAGGIO LAW at (601) 265-6869 to schedule a free, confidential consultation.