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Understanding Workers' Compensation Claim Denials And Appeals

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The workers' compensation process may seem cut-and-dry, and for many people it is. Unfortunately, you may find yourself with a denied workers' compensation claim. There are a few reasons this can happen, and there are things you can do if it does happen.

The Reasons for Denial of Workers' Comp Claims

There are many reasons for denial of a workers' compensation claim. A denial letter will contain the reasoning. Some of the most common reasons include:

  • Not filing or reporting in time, either by you or your employer
  • Doubt as to whether you suffered an injury
  • A report from the health care provider stating you're not injured
  • Disputes from the employer

These things can occur for any number of reasons, including malicious intent on the part of your employer. For example, an employer may flat out refuse to acknowledge that your injury occurred while at work. The employer may claim that your injury was due to a preexisting condition.

There are some other reasons you may receive a denial as well. No matter the reason, you should understand that you have a right to appeal the denial.

Appealing a Workers' Comp Claim Denial

Just like the laws governing workers' compensation claims, the appeals process varies by state. The first thing you need to do is figure out how the appeals process works for you. The denial letter itself may tell you how to start the appeal. You can also check your state's website.

Another option is to call your employer or your employer's workers' compensation insurance rep to get some clarification on the reason for the denial. In fact, you should do this first, and immediately. It's not unheard of for the insurer to have made a mistake when filing. You can even ask them to reconsider.

But it's important that you don't linger on this part. Just like filing the claim itself, you will only have a certain amount of time to file the appeal.

Yes, You Should Hire an Attorney

The best thing you can do about your workers' compensation claim is to hire an attorney. (Places like http://www.nccompspecialist.com/ can be of assistance, here) In cases where the injury is a minor one and there's no realistic expectation of denial, then a lawyer probably isn't necessary.

You should consider an attorney for any injury that will have an impact on your ability to work. Actually, any injury that goes beyond a quick trip to the doctor means that your workers' compensation case will have to consider further complexities.

A lawyer can help you file the paperwork you need to file within the proper time frame. They can also help you to understand exactly what it is you should claim, such as surgeries or continuing doctor visits.

Beyond the initial claim, a lawyer becomes imperative during the appeal process. If you're uncomfortable speaking to your employer or the insurer, then an attorney can do it for you. They can explain the appeal process to you and guide you though it properly. If in doubt, you can consult with a workers' compensation attorney about your case from the outset.