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Understanding Workers Compensation Denial

The attorneys at Murnane & O’Neill work with clients to receive compensation for workplace injuries. Here, the workers compensation attorneys explain why some claims are denied, and what can be done about it.

Workplace injury is a serious issue for which it can be difficult to obtain compensation. Such injuries can be caused by a one-time accident, such as a machinery malfunction, or a recurring one, such as chronic sickness from exposure to toxic chemicals.

Ideally, every worker would receive the compensation they are due, but sometimes compensation claims are denied. Here are a few reasons why:

Claim Not Filed On Time:

Workplace compensation claims have to be filed quickly, usually within days of the event in question. The workers compensation insurance carrier also has to be informed shortly after the injury is reported. Delay in injury reporting is cited as one of the most common reasons for denial of a claim, and acting with haste can be the difference between receiving your check and receiving a rejection letter.

Employer Dispute:

Workers compensation is an added cost and strain on a company, and moral obligation to compensate an injured employee doesn’t always rank as highly as keeping profits high and costs low. An employer may dispute the accident, claiming that the injury never occurred at work, or that it occurred in a way that doesn’t qualify for workers compensation. It is essential to the validity of your claim that you gather additional evidence in case an employer disputes it.

The Injury Does Not Qualify:

Some states do not allow workers compensation for certain issues, such as stress-related injuries. If an injury does not fall within guidelines designated by your state, then a compensation claim could also be denied.

If you receive your letter regarding your workers compensation claim, it may state whether your claim has been approved or denied. When a claim is denied, the notice should give you an explanation as to why, and tell you how to file an appeal. The appeal process varies in every state, but it may be wise to check with your employer to ensure that the paperwork was submitted correctly. Mistakes in paperwork can occur, especially if you work for a very large company. If the denial was the result of a mistake, then the issue could be resolved with relatively little hassle.

If the employer dispute was not a mistake, you should contact an experienced workers compensation attorney to discuss your case. This attorney will be able to help you navigate the formal appeals process and serve as your representative during administrative hearings. They may also provide you with guidance on collecting evidence to support your case, including witnesses, photos or videos, doctor’s notes or testimony, and/or emergency room reports.

You should never assume that a denial of your initial claim is the end of the process. While the appeals process can be long, stressful, and complicated, there are ways to obtain the compensation that you rightfully deserve. For the best outcome, it is critical to have a legal expert such as the attorneys at Murnane & O’Neill on your side. Contact our law firm today to discuss your case.