Have you submitted a workers’ compensation claim for an injury at work and received a denial? In the past, many insurance companies had policies of denying initial claims. However, most claims that were initially denied and appealed received approval within one year and had significantly higher payouts (up to 55% greater) than those that were immediately approved.
Although many companies have removed this policy, they are for-profit organizations and will look for any valid reason to deny claims. Therefore, these are things you can do if you receive a workers’ compensation claim denial.
Find out why
First, read your denial letter carefully because it could outline why you received a denial. If it does not specify, contact the workers’ compensation insurance company and ask for a reason.
The insurance company may not believe that the injury is work-related, especially if it was not reported immediately after the incident occurred. Your employer can also dispute your claim. If you never received medical care or the evidence does not support your injury you could receive a denial.
Although there are some exceptions, claims filed after you leave your job are typically denied based on state regulations. They also have reporting deadlines, claim submission requirements and injury restrictions, including psychological or cumulative injury challenges.
Appeal the denial
Next, ask for appeal paperwork, and file it within 30 days. Collect your documentation and prepare for your appeals hearing in front of an administrative law judge. The company may also request a mediation or settlement conference.
If you are looking at a workers’ compensation claim denial, do not give up yet. You may still receive your benefits. If you find evidence of irregularities, errors or fraud during the process, speak with the US Department of Labor’s Workers’ Compensation Administration Office.