What to Do When an Employer Denies Your Workers’ Compensation Claim

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Most employers offer workers’ compensation to their employees for all on-job injuries and accidents. If you get injured or have an accident at work, your medical expenses will be covered by a workers’ compensation insurer. Most people think claiming workers’ compensation would be a simple process, but it is not. Statistics suggest that 7% of workers’ compensation claims are initially denied, and the employees have to appeal for what the employer owes them.

An employer can deny claims for numerous reasons. In most cases, if you are able to provide enough evidence to challenge the reason for denial, you will get fair compensation. In other cases, proving your eligibility may not be so simple. The worker’s compensation claim process has many legal complications, which you can resolve with the help of an experienced lawyer.

Is your workers’ compensation claim denied? If yes, this blog post will help you understand what you should do if your employer has denied your workers’ compensation claim.

Understand Why Your Claim Was Denied

The first thing that you need to do if your employer denies your workers’ compensation claim is to understand why your employer denied it in the first place. There could be several reasons for the denial. Some of the most common reasons are:

  • You didn’t file a claim on time. Some states require workers to file a workers’ compensation claim within 30 to 90 days. 
  • The Employer claims that the incident happened outside the work premises
  • The employer doesn’t find the injury compensable (like stress-related injuries)
  • You didn’t get any medical treatment for the injury that you filed for the workers’ compensation claim. 
  • You didn’t provide enough evidence to prove the injury took place at work.
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Talk to Your Employer

Talk to your employer and discuss the denial further. Address the reason mentioned in the denial letter and try to convince your employer that you are eligible. Many times, it is only a misunderstanding that often leads to the denial of workers’ compensation claims. Talking to your employer to make them understand where and how the incident happened, how it affected you, and what medical expenses you had to bear can make your employer reverse the denial.

Hire a Workers’ Compensation Lawyer

If your employer (or the insurer) is adamant that you don’t qualify for workers’ compensation and you believe otherwise, you should consider hiring a workers’ compensation lawyer. A workers’ compensation lawyer will help you collect evidence and prepare paperwork for the hearings that’ll follow your appeal. They will also ensure that you file an appeal within 30 days (or whatever number your state has set) after you receive the denial. 

The workers’ compensation lawyer will obtain all medical records to prove you were hurt and got medical treatment. They will cross-examine the employer and insurance company witnesses. All in all, they will dive into your case to present before the judge the smallest details that could turn the case in your favor. They will also work on settlements to get you the best deal.

Final Word

The workers’ compensation claim process isn’t very pleasant. The employer wouldn’t want to take responsibility for the accident because it could put the employer in a lot of trouble, primarily for not having the appropriate safety measures in place for the employees. The insurance company would try to use whatever they can find to prove that you aren’t eligible. 

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When you decide to challenge a denial of your workers’ compensation claim, you need to stick to your facts, cooperate with your lawyer, and have all the proof ready to prove that you were at work when the incident happened. This includes your workplace timesheet and attendance, medical records, and copies of all the paperwork you submitted with your claim. Your lawyer will do the rest of the work to ensure you get what’s rightfully yours.