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What Should I Do If My Workers’ Compensation Claim Gets Denied?

Denied Claim | 2H Law

Workers’ compensation is a system of insurance that provides benefits to employees who are injured or become ill due to their job. Workers’ compensation is designed to replace a portion of an employee’s lost wages and to cover the cost of medical treatment for workplace injuries and illnesses. You can do a few things if you have been injured at work and your workers’ compensation claim has been denied. Keep reading to learn more about what to do in case of a denied claim.

In most states, workers’ compensation is mandatory, meaning employers must provide their employees coverage. However, there are a few exceptions to this rule.

Don’t panic – denials are common

Denials are standard. Insurance companies are estimated to deny about 60% of all workers’ compensation claims.

There are several reasons for your denied claim. The most common reasons for denial include the following:

Your injury is not work-related: One of the most common reasons for denial is that the insurance company does not believe that your injury is work-related. For example, if you hurt your back while lifting boxes at work, your claim may be denied if the insurance company believes that a pre-existing condition caused the injury.

You did not follow the proper procedures: Another common reason for denial is that the injured worker did not follow the proper techniques for filing a claim. For example, your claim may be allowed if you notify your employer of your injury within the required time frame.

Workers’ compensation does not cover you: In some cases, workers’ compensation claims are denied because the workers’ compensation insurance policy does not cover the injured worker. For example, if you are an independent contractor, you are not typically covered by workers’ compensation.

Get organized and review the denial letter

If your claim has been denied, the first thing you should do is get organized. Gather all your medical records, bills, and any other documentation related to your injury.

Then, take a close look at the denial letter from the insurance company. The denial letter should explain the specific reasons why your claim was denied.

Common reasons for a denied claim are stated above.

Contact an attorney specializing in a denied claim.

If your claim has been rejected, you should consider contacting an attorney specializing in workers’ compensation. A workers’ compensation attorney will be able to review your case and help you determine the best course of action.

An attorney can also help you navigate the appeals process and will be familiar with the laws in your state.

Gather evidence to support your claim

If you decide to appeal the denial of your workers’ compensation claim, you will need to gather evidence to support your claim. This evidence can include the following:

  • Medical records: Be sure to include all medical records related to your injury, including notes from your doctor, copies of x-rays, and hospital records.
  • Bills and receipts: Include all invoices and receipts related to your injury, including medical bills, prescriptions, and lost wages.
  • Witness statements: If there are any witnesses to your injury, get written reports from them. These statements should describe what they saw and how your injury occurred.
  • File an appeal
    If you decide to appeal the denial of your workers’ compensation claim, you will need to file an appeal with your state’s workers’ compensation board. The appeals process can be complex, so it is essential to have an experienced workers’ compensation attorney. Each state has its own workers’ compensation appeals process, so be sure to follow your state’s specific requirements.
Contact and visit us at 2H Law

If your claim has been denied or if you have any questions about the workers’ compensation appeals process, contact 2H Law at (619) 374-9320.  We are a law firm specializing in workers’ compensation and can help you navigate the appeals process. We offer free consultations, so call us today to schedule a visit.

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