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What to do after the denial of your workers’ compensation claim

On Behalf of | Oct 19, 2017 | blog, Firm News

Going to work each day is a kind of social contract. You agree to perform special functions for your employer, and your employer compensates you for that effort with money and potentially additional benefits. You do your best to work hard and support yourself (and your family), but then there was an accident. Work accidents are incredibly common. It only takes a second for spilled coffee to cause a slip-and-fall or a machinery error to result in catastrophic injuries.

You did everything you should have done. You advised your manager or supervisor of the accident. You sought on-site medical evaluation, if your employer provides that. From there, you went on to get medical treatment from your own doctor or the local hospital. You filed a workers’ compensation insurance claim, expecting adequate coverage of your lost wages and medical bills. Unfortunately, your claim got denied, meaning no coverage for your expenses and losses from your work injury.

Why are claims denied sometimes?

Sometimes, a denied claim is a matter of miscommunication. If you reported the accident to your employer, someone else in management or human resources may have failed to fill out a necessary form. That omission later led to someone else denying your claim, since that person wasn’t aware of your injury.

Other times, employers are simply hoping to keep costs down by denying the facts of an accident. Perhaps your employer claims the accident didn’t happen, or maybe the denial implies the injury already existed. Your employer may even try to deny you coverage because you went to an outside doctor instead of their staff medical professional. Whatever the reasoning, you shouldn’t let an initial denial upset you. You have the right to appeal and receive the benefits that you deserve.

You have the right to appeal a denial

The whole point of workers’ compensation is to ensure that those who work hard for a living don’t end up injured and unable to care for themselves or provide for their own financial needs. Those who get hurt while working deserve to have their medical expenses and lost wages covered. In order to protect the basic rights of workers from unfair denials and corruption, there are legal processes in place that allow workers to appeal a denial of workers’ compensation coverage.

Appealing a denial can be stressful. You will need adequate medical documentation of the injury. Ideally, if your employer denies the accident, you will also reach out for corroborating statements from witnesses who work with you. In some cases, there could even be security camera footage of the accident. Barring that, medical records from the day of or shortly after the accident can also help your case, as can any paperwork you initially filed with your employer.