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What you should do if your workers’ compensation claim is denied

On Behalf of | Jun 18, 2022 | Workers' Compensation |

If you received an injury at work, you are typically entitled to workers’ compensation. However, this process can be challenging.

In numerous cases, workers’ compensation claims are initially denied. At this point, many claimants drop the issue, but if you are willing to fight for your compensation, studies show that you may receive up to a 55% greater amount. Therefore, these are steps you can take if you receive a workers’ compensation claim denial.

Ask why

The insurance company may have several valid reasons for denying your claim, e.g., you did not receive medical treatment, your employer denies that your injury occurred on the job, you missed your filing or injury reporting deadlines, there is evidence that you were at least partially at fault, you had a preexisting condition, you received your injury outside of work or the company does not award compensation for your type of injury. In addition, if you no longer work for the company, especially if you filed the claim after you left, you may experience a denial. Therefore, you need to contact these professionals to learn why you received a denial.

File an appeal

Your next step is to file an appeal with the workers’ compensation insurance company. Then, gather your documentation of the injury, witness statements and medical records.

Prepare for a hearing

The insurance company could request a settlement conference or mediation, where you negotiate on a settlement, or an administrative hearing, where a judge determines your settlement.

To prevent a workers’ compensation claim denial or strengthen your case during the appeals process, learn the requirements of the insurance company, such as providing a personal recorded statement and witness statements. Also, avoid actions, such as working under the influence, initiating fights or horsing around, that could damage your case.

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