Denied? Take Action For Problematic Workers' Compensation Issues

Posted on: 27 June 2019

Workers' compensation claims, for the most part, pass easily through the system without issue. When things work as they should, the hurt worker receives free medical care and a disability wage until they are cleared to come back to work. Unfortunately, there are some opportunities for the claim to be denied. If you've been injured in a work-related accident or are suffering from an occupational illness, it's important that you not give up when you get a denial message in the mail. There are steps you should take so that you can be approved for the benefits you need, so read on and find out how to take action.

Follow Up on the Denial

It can be shockingly easy to make mistakes on a workers' compensation claim form. They are not often user-friendly. When you get a denial notice, examine the reason for the denial. Often, the issue can be addressed without having to take it any further. To get clarification on the denial, phone the insurance carrier and find out how to amend or correct the claim form. Details about the accident are very important and the form must be filled out completely. In some cases, the carrier will ask that you submit more information about the accident or your injuries. Only take the next step if you are unable to get your claim back on course after working with the carrier to address any issues.

File an Appeal

At this point, you should strongly consider getting some support from a workers' comp lawyer. Having a denial on your hands is serious and your career and your financial future are at stake. You often must follow a precise procedure when you request an appeal and there are usually deadlines to abide. No matter what is happening with your case, unless you have clear proof that your claim has been approved, don't miss the appeal deadline. You will be asked to submit documentation that supports your claim in preparation for the next steps.

Go Through Mediation

While it's not required in all cases, you might as well be prepared to participate in mediation. A series of meetings between you and representatives of the insurance company can help you try and work out issues and avoid taking the case before the board of appeals. These meetings are presided over by a neutral mediator, and any issues that can be resolved become official.

Attend the Appeal Hearing

The way the hearings are run can vary. Some are like court hearings and some are more like casual meetings. Only the reason for the denial is discussed, so your lawyer and the other side will present witnesses and evidence that support the claim or denial. In many instances, this is the end of the road for a worker's compensation case. In some cases, hurt workers can file a civil case against the employer or the insurance carrier. Speak to a workers' compensation attorney from a company that offers law firm services for more information.