My Workers Compensation Claim Was Denied. Now What?

workers-compensation-claim-denied

It is not unusual to have a workers compensation claim delayed or denied. It is actually very common. There are many reasons why this may happen. Hopefully, your employer and insurer are not acting in bad faith and are denying your claim for legitimate reasons. Fortunately, a denial does not mean the process is over. You can appeal the decision and eventually get your claim approved. Our lawyers at Bighorn Law are skilled with workers compensation issues and the appeal process. Contact us today, and we can help you get the compensation that you need.

Why Was My Claim Denied or Delayed?

There are several different reasons why the insurer may have not approved your claim. According to AllLaw.com, some of these reasons include:

  • Lack of medical evidence or missing paperwork
  • There were no witnesses when you were injured
  • You didn’t report instantly or missed the deadline
  • Your injury was caused by a preexisting condition
  • You were not at work when you were injured
  • There were drugs or alcohol in your system
  • No evidence that the injury was industrial
  • Red flags on your injury report

Your employer or the insurer should tell you the reasons why your claim was denied. If they don’t, you must ask them because that information will be critical for your appeal. Sometimes the insurance adjuster is missing important paperwork, or something has been filed incorrectly. In certain situations, you can clear up these problems quickly without going through the appeals process.

What Should I Do After My Claim Has Been Denied?

Some of the reasons for denial will make it very difficult to get a successful appeal decision. It really depends on your exact situation, and that’s why it’s very important that you immediately get the help of a workers compensation attorney. An attorney specializing in workers compensation can help you figure out why you were denied, and he can tell you if your appeal has a good chance for success. If you do not want to hire an attorney, you can also go to the Workers Compensation Appeals Board and get help from an Information and Assistance Officer. I&A officers can usually help just as much as an attorney can.

File Your Appeal Application

Now that you are working with an attorney, you should immediately file your application, which is called an Application for Adjudication of Claim. Think carefully about why your application was denied and do your best to address those issues. If some coworkers were casting doubt on your injury, you might want to collect testimony from coworkers who can verify that it actually happened.

Whatever the situation is, your attorney will work with you to address the issues in your injury report and build a strong case for your appeal. When an insurance company denies your claim and accuses you of not being truthful, it is easy to take the denial personally. Remember to remain calm and respond in a respectable and legally appropriate way. This will give you a better chance of winning your appeal.

Bighorn Staff

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