What to Do if Your Work Comp Claim Is Denied

Getting injured as a result of your job is an awful experience. You may feel some relief in knowing that you don’t have to worry about paying your medical bills or losing income because of workers’ compensation. Therefore, it can come as quite a nasty shock to receive notification from your employer’s work comp insurer that your claim has been denied. You do not have to just accept this decision, though. You can challenge the denial of your workers’ comp claim with an appeal. However, as with filing a claim, you need to be sure that you follow the correct procedures.


Find Out Why the Claim Was Denied

This should be a relatively simple matter. You should receive a letter from the workers’ comp insurer that gives a reason for the denial of your claim. Sometimes the denial occurs because of a mistake or oversight on your part. There are strict guidelines in place that govern when and how you must report your injury and file a claim. If you missed any of these deadlines, that may be grounds for denial. You can still appeal a denial on these grounds, but it may affect your ability to recover full compensation. Your claim may also be denied if you were under the influence when you were injured, your injury resulted from horseplay, or if you did not receive medical treatment for your injury.


Sometimes your claim is denied for reasons beyond your control. Either your employer or the insurer may raise questions about whether your injury was really work related or if it is serious enough to warrant compensation. You may also have a problem recovering compensation if your injury or illness is mental, rather than physical.


Arrange a Meeting

Before filing a formal appeal it may be helpful to meet with your supervisor, HR manager, or a representative from the insurance company to see if you can resolve the issue. Your denial may have been the result of a clerical error or other simple mistake. However, if your employer or the insurance company refuses to reconsider your claim, you must file an appeal.


Gather Evidence

If your workers’ compensation claim is denied, it becomes your responsibility to prove that you deserve compensation. Therefore, you should gather any available evidence that supports your claim. Examples include medical records and accounts from eyewitnesses who saw what happened.


File an Appeal

As with filing your initial claim, there are usually deadlines you must meet to file an appeal. Your denial letter should delineate the proper time frame. Because the laws that cover workers’ compensation can be complicated, it can be helpful to hire a workers’ compensation attorney, like a Newark workers’ compensation attorney, to assist with your appeal. 


Thanks to Rispoli & Borneo, P.C. for their insight into what to do if your workers’ compensation claim is denied. 

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