My Employer And The Insurance Company Have Denied My Claim For WC - What Should I Do?
On Behalf of Rosenthal, Levy, Simon & Sosa | August 10, 2022 | Workers' Compensation
If you have been injured at work, it can be incredibly disheartening to find out that your workers' compensation claim has been denied. Every year, thousands of workers in the United States face a rejection of workers' compensation claims, but that doesn’t mean there is nothing you can do about it. There are ways that you can appeal your claim, and it might be beneficial to speak with a Port St. Lucie workers' compensation attorney first.
At Rosenthal, Levy Simon & Sosa, we understand how challenging it can be for a worker to focus on their recovery if they are facing weeks to months of being unable to work with little or no income. If you have suffered a job-related injury, we can help you file a workers' compensation claim to determine what benefits you're eligible for.
Additionally, should your claim be rejected by your employer and insurer, we can work alongside you to help you determine the best course of action. We have written this article to help give you an idea of what you can do.
What Are The Common Reasons Why Employers And Insurers Deny Workers’ Comp Claims?
There are many reasons why employers and insurers deny workers' compensation claims. Knowing more about why your claim was denied can help you during the appeals process. See below to learn more about the most common reasons why this type of claim is commonly denied.
- Disputes surrounding your injury being work-related: Often, a workers' compensation claim is denied because there are disputes surrounding if an injury or illness is work-related.
- Missed deadlines: Many are denied benefits because they have failed to provide their employer with a written notification of their illness or injury within 30 days. Additionally, a claim needs to be filed within two years of the date you sustained your injuries at work.
- There are issues with your paperwork: One of the simplest reasons for denial is that your paperwork was not filed correctly, or you did not fill in all the information correctly.
- There is a lack of medical documentation: When a worker is filing a claim for worker compensation benefits, there need to be medical records proving injuries. If a claim does not have medical documentation like copies of medical records and doctor's treatment notes, a claim will likely be denied.
- You did not seek immediate medical care: Some workplace injuries and illnesses are not apparent for days, weeks, months, or years. Despite this, many employers and insurance companies will argue that if you did not immediately report your work-related incident, it did not occur at your workplace.
- There were no witnesses: Unfortunately, if no one witnessed a workplace injury, an insurance company and employer can exploit the uncertainty surrounding where your injuries happened.
What You Can Do If An Employer And Insurer Have Denied Your Workers’ Compensation Claim
When an employer and insurer have denied your claim, you have options. The first thing you should do is determine why your claim was denied. Usually, you will receive a letter detailing the exact reason your employer and insurer do not want to grant you benefits.
Should you believe that your claim was denied because of a paperwork issue, you can try to contact the claims adjuster to establish if they can be of assistance. Unfortunately, most times, you will need to appeal the denial, and although you can do this on your own, it's better to use the services of an attorney who has experience with the appeal process.
Usually, the letter denying your claim will include the information you need to appeal the denial. In most instances, the first level of appeal will be to attend a hearing before an administrative judge. At this hearing, you will be required to present supporting evidence, including medical documentation demonstrating that your injuries or illness are job-related.
In addition, you should note that there are levels of appeal beyond the initial administrative levels, so it's best to work with an attorney who can guide you through the process.
Contact A Port St. Lucie Workers’ Compensation Attorney Today To Discuss Your Case
As can be evidenced, appealing a workers' compensation claim denial can be incredibly complex and challenging to navigate. With so many reasons for refusal and limited opportunities for appeal, you should consider speaking with a Port St. Lucie workers' compensation lawyer. Some of the best workers' compensation lawyers in the area belong to the Rosenthal, Levy Simon & Sosa law firm. At our firm, we understand your frustrations and will work alongside you to ensure you have the best chance possible at receiving benefits after an appeal. To speak with us, you can contact us here or visit us in person to arrange an obligation-free consultation.
Don’t wait - get an experienced attorney on your side to help you with everything that comes next so you can get the compensation you deserve or the advice you need when you need it most.