If you’ve been injured on the job, you likely plan to rely on workers’ compensation to help cover medical expenses and lost wages while you recover. All of this comes into question if your workers’ compensation claim is denied. It can be frustrating and confusing to have your workers’ compensation denied, especially when you have valid injuries that occurred on the job or as a result of long-term conditions on a job. If you’ve received a workers’ compensation denial letter and are feeling uncertain about the next steps, it’s important to have a plan. Understanding why a claim might be denied and how to deal with it is crucial.
Common Reasons for Workers’ Compensation Denial
Workers’ compensation claims can be denied for a variety of reasons, and understanding these common denial factors is essential for workers looking to protect their rights and navigate the process.
Failure to Promptly Report Injury to Employer
Ideally, you should notify your employer of your injury or illness as soon as possible. The sooner you’re able to inform your employer, the easier it is to establish legitimacy. Inform your employer, preferably in writing, within 30 days of your injury or once your healthcare provider confirms that your condition is work-related. If you delay notifying your employer, you open the door for them and their insurance company to fight your claim.
Insufficient Medical Evidence
The first thing you should do after sustaining an injury or developing a condition at work is to visit a doctor. Workers’ compensation claims hinge on medical evidence; doctor’s reports are key to diagnosing your condition, proving your injury or illness is work-related, and demonstrating how severe your condition is. Without concrete proof of injury or illness, it’s unlikely you’ll receive any benefits.
Failure to Follow Medical Advice
Simply obtaining a diagnosis isn’t enough to get workers’ compensation benefits. You also need to follow the doctor’s prescribed treatment plan. Failing to take certain medication, follow rehabilitation programs, or even attend doctor’s appointments can all lead to your employer or their insurance agency claiming your injury isn’t being handled properly or isn’t as severe as you claim it is.
Pre-Existing Conditions are Present
If you have a pre-existing condition, your employer or their insurance company will likely argue your injury or illness is due to your condition and not a workplace accident or long-term overuse or exposure. This is also why having medical documentation is so important.
Missed Filing Deadline
Claims must be filed two years from the day of the incident. While employers must report incidents, you should also file your own claim. Do not let anyone try to talk you out of filing your own claim.
Understanding a Workers’ Compensation Denial Letter
If your workers’ compensation claim is denied, the insurance company or a claims administrator will send you a denial letter. This letter serves as the official notice that your claim was rejected. The letter should specify why your claim was denied. It may also reference documents or evidence that led the insurance company to deny your claim. Most importantly, the denial letter should include instructions on how to appeal the decision, along with deadlines for filing an appeal, which is within 30 days of the filing date on the letter.
What To Do After Receiving a Workers’ Compensation Denial Letter
If your workers’ compensation claim has been denied, the attorneys at Lewis & Lewis have the expertise to assess your claim and the reasons for the compensation denial. We can help you secure the benefits you are entitled to. Don’t lose hope if your workers’ compensation claim has been denied. Many denials can be successfully litigated with the right approach and legal assistance. Consulting with an experienced workers’ compensation attorney at Lewis & Lewis can significantly improve your chances of a favorable outcome.
