What Should I Do If My Workers Compensation Claim Is Denied?

Workplace related injuries entitle the injured individual to receive certain financial benefits. In most cases, these financial benefits will provide the injured individual with a stable source of income, 2/3 of the lost wages and compensation for the stress and pain endured. In order to receive workers compensation, one has to previously report the injury to his superiors, and then file for workers compensation claim.

But, what happens if the workers compensation claim gets denied? Is there any way around it, and if there is, what is the next course of action?

Understand Why It Was Denied

To start with, you should understand why the claim was initially denied. There could be several reasons behind it. The most common reasons are:

  • Injury was not reported within the given time – Each state has different laws about the time in which the injury should be reported. Make sure you do report the injury within given time, or lose the ability to receive your financial benefits.
  • Workers compensation claim was not filed in time – The initial claim should be filed within 30 to 120 days, depending on the state law.
  • Your employer disputes your claim – in case your employer believes that your injury took place outside of your workplace, you may have to hire a legal representative and settle the dispute before you again file for work comp claim.
  • Unclear injury – if the injury is stress-related, it may be difficult to prove in many states. However, the state of California specifically covers for stress-related injuries.
  • You didn’t receive medical treatment – in order to be able to receive financial benefits and have your work comp claim approved, you have to undergo medical treatment as soon as the injury occurs. This way, the Administration Board will use the doctor’s report to determine if the injury fails under the category of workers compensation, as well as the amount of money you will receive through the workers compensation.
  • Insufficient evidence supporting your case – if you cannot prove that the injury took place at your workplace, you may need additional medical evaluation and examination to prove your case.

There are many other reasons why your work claim may be denied. To learn more about them, speak to your local workers compensation attorney.

File An Appeal

Once your claim is denied, you will receive a denial letter with a deadline on your appeal. If you choose to file an appeal, you should best leave it to an experienced workers compensation attorney as the process may become more complicated than you could ever imagine.

Before you file an appeal, it is important to meet with the insurance carrier to determine whether the dispute is easy or hard to resolve. Check your state’s laws for more information on the appeal, and be prepared for a lot of stress and exhaustion. Make sure you bring all your documentation, including your medical records after the injury.

To avoid the stress and complication of the process, hire an attorney to handle things for you. Focus on your recovery, and let someone with proper experience take care of your case for you.

Stephen Boutros

About the Author

Stephen Boutros Ltd. is dedicated to provide strong legal representation for all types of personal injury cases throughout Harris County, Texas.

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