The idea behind workers’ compensation is to help employees who are injured or become ill in the course of their work. But getting through the claims process can be difficult, and it happens that valid claims are denied. If your workers’ compensation claim has been denied, you may have reason to hire legal representation. Here’s what you need to know.
Denial of claims has many common reasons –
Workers’ compensation claims can be denied for various reasons, including:
Incomplete or Incorrect Paperwork:
Missing information or errors on your application will lead to a denial.
Missed Deadlines:
If you don’t report the injury to your employer, or fail to bring your claim within the time limit, then you will be rejected.
Disputed Work-Related Cause:
The insurance company may tell you that your injury or illness is not work related.
Lack of Medical Evidence:
If you don’t take adequate care of yourself during the accident period, your case might come out weaker.
Pre-existing Conditions:
Insurers could argue that your injury is caused by a pre existing condition, not an accident on the worksite.
Signs You Need Legal Help
Denials can be resolved by correcting errors or submitting more information to some, but to others professional legal assistance is needed. Consider seeking legal help if:
1. You Face Repeated Denials
If your claim continues to get denied by the insurance company, multiple times, this may be a red flag that it’s unlikely to be approved without drastic intervention. It may be possible that an lawyer would help to identify the problem and craft a solid appeal.
2. Your Employer or Insurer Challenges Your Claim
If your employer or their insurance company disputes either the nature or severity of your injury in a work related way, an experienced Workers’ Compensation lawyer can present evidence such as medical records and witness statements to help you.
3. You’re Offered a Low Settlement
Your insurance company may offer you a settlement that doesn’t cover your medical expenses and lost wages. A lawyer can fight for you to get what you deserve in a compensation.
4. Your Claim Involves Complex Issues
In many instances, the presence of certain types of claims, including those involving permanent disabilities, pre-existing conditions and retaliation from your employer need to be handled by a lawyer. These cases can be complicated, as the law is involved and it is easy to make mistakes if you don’t know what you are doing.
5. You’re Unsure About the Appeals Process
Submission of a denied workers compensation claim involves strict deadlines, legal procedures and much compelling evidence. Your workers’ compensation lawyer can help you through the process, making sure all requirements are met and that your appeal is strongest it can be.
Benefits of Hiring an Workers Compensation Lawyer
An experienced workers’ compensation lawyer can:
Evaluate Your Case:
Know why your claim was denied and if you have basis for an appeal.
Gather Evidence:
You’ll have to get medical records, expert testimony and other documentation to strengthen your case.
Negotiate with Insurers:
Negotiate with the insurance company to receive a fair settlement in communications and handle the company’s communications.
Represent You in Hearings:
Make your interests known at administrative hearings or court trial.
Don’t Wait to Seek Legal Help
Workers’ compensation cases turn on the requirement for a quick response. Delaying legal action might impact your chance to get benefits. If you are denied your claim or if the process is not going well, call a qualified workers’ compensation lawyer as soon as possible. They can also protect your rights and go after the compensation you’ve been legally entitled to.
