Workers Compensation Claim Denied? Here’s What You Need to Know

What to do when your workers' compensation claim is denied.

Clerical errors may seem innocent enough, but they can be a significant reason for a workers’ compensation claim denial. Mistakes like mixing up paperwork or missing a filing deadline can cause the insurer to block your benefits.

To avoid being denied, consider having a trusted workers’ compensation attorney manage your case from start to finish. They can review all evidence with a practiced eye and ensure your claims forms are correctly filled out.

You Didn’t Seek Medical Treatment

Insurance companies and employers can deny workers’ compensation claims when they aren’t satisfied that an injury or illness happened at work. For example, they may think the worker got hurt while fooling around or was not on the job. An experienced workers’ comp attorney can increase the likelihood of having this decision reversed.

It’s also essential for the worker to get a thorough diagnosis and follow the doctor’s treatment plan. If a worker skips visits or doesn’t adhere to the doctor’s recommendations, the insurance company may not approve the claim. In some states, a workers’ comp insurer can require the injured worker to see a specific healthcare provider, but this is only for the first visit, and it’s possible for the injured worker to choose a different doctor (Massachusetts law allows this). Then, the patient must pay their medical bills until workers’ comp reimburses them.

You Have a Preexisting Condition

A worker’s compensation insurer might question your claim’s validity for many reasons. They may have overlooked a detail, or they might be trying to make it difficult for you. Regardless, it would help if you always had an experienced first time workers compensation claim Oregon attorney to manage your case, as it is in your best interest.

Preexisting conditions are a hot topic as Senate Republicans work on health care legislation. The issue is whether or not people who have a preexisting condition can be denied coverage in the individual insurance market.

In workers ‘ compensation cases, an insurance company might argue that a preexisting condition caused your injury or illness. You can fight this by having an agreed medical evaluator evaluate your case.

You Filed Your Claim After You Left Your Job

If you were injured on the job and then quit, it may be harder to substantiate your workers’ compensation claim. Insurance companies are suspicious of lawsuits filed by former employees because they see it as a way to collect a weekly paycheck (since people who quit their jobs willingly are not eligible for unemployment benefits).

It is crucial to notify your employer as soon as possible when you become ill or are injured. There are time limits in place – usually 30 days – and you must present substantial evidence that the injury or illness is work-related. A knowledgeable workers’ comp attorney can help you through this process and ensure you receive the maximum benefits.

You Didn’t File Your Claim Within Two Years

Insurance companies often use the fact that an employee did not file their claim within two years of their injury or illness as an excuse to reject their workers’ compensation claim. This is why it is essential to always file your claim immediately after the incident.

It is also essential to fill out all paperwork completely and accurately. Even a minor mistake or misunderstanding on one piece of paperwork can lead to your denial. Filing all the correct documentation and details about your injury or illness is essential.

If you get a letter rejecting your claim, speak with a knowledgeable workers’ compensation lawyer immediately. They can evaluate your situation, outline your rights, and assist you with appeals.

You Filed Your Claim Outside the Statute of Limitations

Even if your injury or illness is work-related, it will be denied if you filed it outside the statute of limitations. This is why it is essential to report your injuries promptly.

You may appeal by obtaining a refusal letter from the workers’ compensation board. The process varies by state but typically includes a hearing before an administrative law judge.

You can also appeal your case to some states’ highest court, but this is rare. When filing an appeal, having a skilled workers’ comp lawyer on your side is best. An attorney can help you gather the medical evidence and other documentation to support your claim. An experienced attorney can also fight to ensure that any preexisting condition is not blown out of proportion and used to deny your claim.