If you have suffered workplace injuries that led to hospitalization and time away from work, you may be struggling to maintain financial stability. Although the workers' compensation insurance program is a no-fault system, some claims are denied. When this happens, it can compromise your ability to take care of your family. There are many reasons for workers' comp claims to be rejected, including some of them that involve requirements that were not met.
Some reasons for Workers' compensation claim denials:
- Reporting requirements not met -- You must inform a supervisor or employer about an on-the-job injury within a given time -- preferably in writing.
- Claim filed too late -- You must submit your workers' compensation benefits claim within a period prescribed by your state. This can be between 30 and 90 days.
- Employer disagrees -- Your supervisor may indicate that your injury resulted from horseplay in the workplace, or that you were not at work or on duty when you suffered the injury.
- The absence of medical treatment -- Evidence of medical treatment must typically accompany benefits claims. However, you might have suffered severe emotional trauma when you witnesses a catastrophic accident at work, requiring some days of recovery and resulting in a certain loss of income. In such a case, it may be best to consult with a physician to provide medical proof of your need to recover.
- Compensability of injury was challenged -- Some injuries are not as apparent as a leg in plaster or an amputated finger. Your employer may disregard your soft tissue injuries that resulted from days of repetitive motions at work, only because he or she cannot see it.
- Lack of evidence showing injury to be work-related -- You may have to provide additional medical or other evidence to prove that your injury is work-related. If your claim was for an occupational illness, proving it was work-related might be challenging.
You are entitled to appeal the denial of a workers' compensation benefits claim, but before you do, you may want to arrange a meeting with the insurer or your employer to make sure the rejection was not an administrative error. If you then want to proceed with an appeal, it may be wise to utilize the services of a seasoned workers' compensation attorney to advocate for you and guide you through the administrative and legal procedures.
The letter that advised you of the denial will provide a date by which you can launch an appeal, and an experienced attorney will explain the process after assessing the viability of a claim. He or she will also make sure you have the necessary documentation to help prove eligibility for compensation. You may be required to go for further medical examinations, and you may want to obtain a copy of a signed time sheet to show that you were on duty at the time of the accident. Based on the state's requirements for appeal of denied workers' compensation claims, your lawyer will work toward the best possible outcome that may include fair compensation.