Worker’s Comp Denied? Here’s What to Do Next

/ Oct 11, 2018 / In Workers' Comp - Workplace Injury / By

workers comp deniedOver 150 Americans are killed per day due to work-related causes. Another 3.8 million suffer from work-related injuries or diseases each year.

Unfortunately, even if a working environment clearly led to an injury, some businesses are reluctant to provide workers’ compensation benefits.

If you recently had your workers comp denied, don’t lose heart. Nearly 70% of denied claims are converted and paid, and yours can be, too. Here’s how to appeal your claim and obtain the money you need for your injury.

Workers Comp Denied? Here’s What to Do

It’s very disheartening to receive a denial in the mail. However, there is a way to appeal your claim.

1. Search for Reasons

Most denial letters contain a reason explaining why your claim was denied. Common reasons include:

  • Missed deadlines
  • Unreported injuries
  • Contested injuries
  • Nonexistent medical treatment

Analyze the reason provided carefully. If you believe you can gather the evidence to dispute it, continue to the next step. If you think it’s a valid reason or you can’t compile evidence, reconsider your efforts.

2. Discuss Your Situation with a Lawyer

If you continue with the appeal, it’s best to seek the help of a workers’ compensation attorney. Most attorneys work on a contingency fee basis, meaning they won’t receive payment unless they win your case.

While many individuals might be reluctant to hire an attorney, they are invaluable. Workers compensation laws are strict, so it’s best to have a knowledgeable professional at your side.

3. File for an Appeal

The appeals process varies in every state.

In Texas, workers must submit documentation for a benefit review conference. At this informal meeting, an officer attempts to find a resolution that you and the insurance company agree on.

If an agreement is reached, the process ends here. If the dispute continues, individuals take the appeal to the next step.

If you hire an attorney, you stand a much greater chance of saving yourself time and money by ending the process here.

4. Collect Evidence

An attorney will do this for you, but if you choose to represent yourself (and even if you don’t), collect as much evidence as you can to bolster your case.

Consider:

  • Witnesses
  • Medical records and bills
  • Written diagnoses by doctors
  • The paperwork you used to report the incident
  • Photos of the injury

Write down everything you recall about the event. All of this information can strengthen your case for the appeal.

5. Beyond the Benefit Review Conference

If an agreement couldn’t be reached at the benefit review conference, you have two options. Arbitration is the least expensive and quickest route to a decision. At this semi-formal meeting, both sides present their information and the arbitrator decides the outcome.

This decision cannot be appealed.

At a contested case hearing, which is similar to a trial, cases are presented to an officer. The officer mails each side his or her decision.

Unlike in arbitration, this outcome can be appealed to the Division of Workers’ Compensation Appeals Panel. Written cases are sent to the panel, who provides a final decision.

Get the Assistance You Need at a Free Consultation

Many people have had their workers comp denied, but it’s far from a final decision. Instead, use the resources available to you to reach a just outcome.

Do you need help with a claim? If so, contact us today for a free consultation. It’s time to obtain the money you need to pay for the medical bills and missed work your injury caused.

Related Posts