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Appealing a Workers’ Compensation Denial

Goldstein Heslop Steele Clapper Oswalt & Smith Dec. 10, 2021

When you are hired for a job, you intend to show up; however, when a workplace accident occurs, you are suddenly faced with the inability to work. Whether it is for the short-term or a long duration, a work injury often requires medical care and time away from work to recover. An injured employee is often focused on the pain they are currently suffering, they do not right away consider the financial hardships that befall on them due to medical bills and lost wages.

Seeking Workers’ Compensation

When a workplace accident occurs, the injuries that result are commonly covered by the employer’s workers’ compensation insurance. This requires file a claim for workers’ comp, indicating the injury that occurred in course of employment. However, applying for these benefits does not mean an injured employee will be instantly approved. In fact, some of these claims are denied.

Overcoming a Denied Claim

Workers receiving a denial for workers’ compensation benefits have the ability to appeal this decision. When taking such as action, it is imperative to understand why the claim was denied in the first place. There are six common reasons for denial.

First, a denial could occur if the injury was not reported in time. Typically, an injury must be reported to a supervisor within a few days of the incident. Next, if the claim is not filed in time, which is typically 30 to 90 days, it could be denied.

A third reason for denial is when an employer disputes the claim. An employer may assert that the accident did not happen at work, was the result of horseplay or other reasons to disqualify the claim.

Other reasons for denial include the injury not being compensable, no medical treatment was required or there was insufficient evidence that the injury occurred.

Filing an Appeal

Once the reason is understood, a good first step, if applicable, is to speak with your employer. This could help settle the matter. Next, it is important to collect any and all necessary documentation and medical records that could help prove the injury, that it occurred at work and that it resulted in damages.

Appealing a workers’ compensation claim denial can be a confusing and complex process. It can be beneficial to take steps to understand your legal rights and options to move forward with this action.