What To Do When Your Workers Compensation Claim is Denied?
Workers’ compensation provides a level of protection for employees who suffer from work-related injuries by providing financial help for medical expenses, lost wages, and so forth.
Unfortunately, the process of filing for these benefits can be a bit complex, increasing the risk of a denied claim.
How does this happen? What should you do when your workers’ compensation is denied? Here is what you need to know.
What Can Cause a Workers Comp Claim to Be Denied?
Workers compensation claims are denied every day — and for many different reasons.
Non-Work Related Injury
Sometimes insurers may feel as though the injury is a pre-existing condition or something that didn’t happen as a result of your work. If there is any dispute about how, where, or why the injury happened, it may be denied.
Missed Deadline
There is a deadline to inform your employer of your workplace accident or injury. It will vary from state to state, but in Tennessee, you have 15 days from the date of occurrence to report it to your management team and one year to file a claim with the workers’ compensation office.
Missing these deadlines can lead to a denial.
Insufficient Medical Evidence
Your medical documents should be linked to the injury, proving that it happened as a direct result of your work. If it is not sufficient enough, appears unrelated to work, or you didn’t seek medical treatment at all, insurers can deny the claim.
Your Employer Disputed the Claim
If your employer believes that your injury did not happen at work or is related to misconduct, they can reach out to the insurer and advise as such. While the claim will still be processed, sometimes it is denied if they feel the employer is correct.
What Happens if a Claim is Denied?
When a workers’ compensation claim is denied, you suffer a greater loss. Not only are you injured with lost wages and mounting medical bills, but you are denied benefits that will help financially.
You have two choices: accept the denial or file an appeal.
How to Appeal Your Workers’ Compensation Decision
Before appealing your denial, it is always a good idea to hire a workers’ compensation lawyer. These cases can be complex and difficult to fight so having the expertise of an experienced attorney can be highly beneficial.
Your first step should be to gather the evidence you will use in your appeal. Make sure it accurately addresses the reason for the denial. You may even bring in witnesses, too.
Work with your workers’ compensation lawyer to ensure that everything is completed accurately and in its entirety. Remain consistent, including as much information as possible.
You have 30 days from the denial to complete the Notice of Appeal provided by the Tennessee Bureau of Workers’ Compensation and formally submit it for review. Be as thorough and accurate as possible as any errors could result in a longer delay.
A hearing will be conducted in front of a judge. This is a time for you to present any evidence and even testify as to the details of your case. Witnesses, doctors, and co-workers may also testify.
At its conclusion, the judge decides the outcome.
Having a workers’ compensation lawyer gives you the greatest opportunity to win the appeal and get the help needed to get back on your feet.