When a work accident or occupational illness or condition leaves you injured, sick and unable to work, you know you need financial support. The purpose behind workers' compensation is to provide care to workers who are hurt on the job, but it can sometimes be surprisingly difficult to actually obtain those benefits.
In fact, some Nebraska workers are discouraged and confused to learn that their workers' compensation claim came back denied, even if they have a valid case. It is fairly normal for this to happen, and while it certainly is frustrating, it is not the end of your options. You have the right to continue to fight for your benefits.
Common reasons for a denied claim
There are many reasons why a claim could come back denied. One of the first steps to appealing and continuing your pursuit of benefits is to understand why the denial happened. Some of the most common reasons for a denial include:
- No evidence that injury required medical care
- Claim not filed in enough time
- Injury not reported promptly
- Employer disputed the claim
- Determined that injury is not compensable
- No evidence that injury is work related
By understanding the reason for the denial, you can know how to approach your appeal. Often, a denial is the result of insufficient evidence, an error in the application or other simple reason. However, it is always beneficial to have guidance when navigating the complexities of the insurance claims process.
There is a limited amount of time available for you to file a claim. There is no time to lose, but quick action is necessary to ensure that you receive what you need for medical care, lost wages and other losses.
Proving your case
The appeals process can be complex. While sometimes simply supplying additional information and documentation is enough, you may be surprised to learn that another medical exam could be necessary. Insurance companies do not have your best interests in mind, and they will work to avoid paying or paying the full amount if it is at all possible.
It can certainly feel like a defeat to get a denial letter in the mail for a workers' compensation claim. However discouraging that may be, it is not the end of the road for you. Protecting your interests may mean fighting through the appeals process, but it is a worthwhile battle for the security and support you need during a time of recovery and missed work.