Suffering an injury at work is a difficult experience; fortunately, many injuries are covered by workers’ compensation insurance. That means a worker must file a claim with their employer for their work-related injury, and they would receive wage assistance and medical care. But what do you do if your employer denies the claim?
Should you have a workers’ compensation claim denied, the next step is to figure out why it was denied. More than likely, you would have received a denial letter from your employer or your employer’s insurance company with their explanation. Some common reasons for an employer’s denial includes:
- They dispute the claim: Your claim may be denied because the employer believes the injury was because of your own wrongdoing or “horseplay”, or the injury occurred outside of work.
- The injury was not reported in timely manner: Your injury should be reported to your employer either immediately or within a few days.
- Claim not filed within timeframe: Every state allows a certain timeframe (usually 30 to 90 days) for a workers’ comp claim to be filed.
- Employee did not receive medical treatment: It is important to immediately seek medical treatment following an injury, especially at work, since most claims will not be covered if there was no medical treatment.
- Injury is not part of workers’ compensation list: Each state has their own list of covered injuries, and there is a small chance your injury is not on the list. Other “stress-related” injuries are not listed and will need further medical examinations to uphold your claim.
Appealing a Workers’ Compensation Claim Denial
The denial letter you received from your employer should explain how to start the appeal process, so be sure to read every detail. Most insurance companies give your 30 to 90 days from the day you have received the denial letter to file the appeal.
Before filing for an appeal, talk to your workers’ compensation insurance company or your employer first. Many times, a simple clerical error prevents the claim from being accepted, so it may save you some time should the issue be something as minor as an administrative error or similar problem, and there could be an easier solution.
Should you have to file an appeal, it will not be in your best interest to go it alone. A workers’ compensation appeal process is lengthy and can get quite complicated, so you should have your claim handled by a reputable workers’ compensation lawyer. Furthermore, the appeals process is different depending on what state you are in, so having strong legal assistance will certainly help navigate the claim’s complexities.
You should gather as much information about your injury as possible for the appeals process and keep it in a folder. This includes items such as medical visits, doctors’ notes, evidence of the injury and where and when it happened. You will likely need a second medical evaluation as well from a third-party.
In the appeals process, there will most likely be a hearing involving an administrative law judge, and there will be multiple levels to the appeal:
- Mediation: This process involves a third-party mediator overseeing the discussion between yourself and the insurance company in an attempt to come to an agreement. The mediator is well-trained and experienced but does not force a decision for either party.
- Administrative judgement: This is when a judge will decide your claim, where your lawyer will defend your claim against the insurance company’s lawyers in a courtroom. Here you can present your evidence, any witnesses of your injury, and your experienced workers’ compensation lawyer.
The Exton Workers’ Compensation Lawyers at Wusinich, Sweeney & Ryan, LLC Help Injured Workers with Denied Workers’ Comp Claims
If your workers’ compensation claim has been denied, then you need the best team by you to achieve the best resolution. Call the Exton workers’ compensation lawyers at Wusinich, Sweeney & Ryan, LLC right away. Our skilled and experience team has years of experience with these types of cases and will gladly help you get the compensation you deserve. Call us today at 610-594-1600 or fill out our online form for a free consultation. With our offices located in Exton, Pennsylvania, we proudly serve all communities of Downingtown, West Chester, Exton, Coatesville, Phoenixville, Malvern, Lyndell, Wagontown, Uwchland, Parkesburg, Chester Springs, Lancaster County, Reading, and Morgantown.
