Faqs About Handling A Workers' Comp Denial

After you file a claim for workers' comp, it is closely evaluated by your employer and its insurance company. There is a possibility that the insurance company could choose to reject your claim. If so, you have legal options for handling the situation. If you recently received a rejection for your claim, here is what you need to know. 

Why Was Your Claim Denied?

The insurance company is required to state on the denial letter exactly why your claim was rejected. Even though the reasons can vary, there are some that are more commonly cited. 

For instance, the insurance company can argue that your injury was not that serious. Other reasons that can be cited include:

• The injury was not work-related. 
• The claim was filed too late. 
• You are not considered an employee, but an independent contractor. 
• You were under the influence of drugs or alcohol. 

A denial letter does not have to be the final word on your claim. Legally, you have options to appeal the decision.

What Can You Do?

Your next action after reviewing the denial letter depends largely on the reason for the denial. For instance, if the insurance company claims that your injury was not that serious, you can provide them with the medical records needed to show that it was. 

If the company claims that your injury was not work-related, you must prove that it was. Witness statements or surveillance video from your place of employment can help to prove your case. 

However, if the reason was more complicated, you can file an appeal with your state's employment commission. Each state has varying procedures, but there are some similarities between them. 

The appeal needs to be filed in writing or at your local employment commission office. You can request a hearing to review your case. During the hearing, you can argue why you are entitled to receive benefits. 

In some states, you might be required to attend arbitration with the insurance company. If so, carefully review the terms before attending. What is decided in arbitration might be final, which means you would have to abide by whatever decision the arbitrator reaches. It is also possible that you will have to go to court to fight for your right to receive workers' comp benefits. 

Your workers comp attorney can help you assess the reason for your denial and help you develop a strategy to overcome it. 

Share