Keep Trying: How To Handle A Workers' Comp Denial

Getting injured at work is no walk in the park, but a workers' comp claim denial could really ruin your day. If you are expecting to be paid your medical expenses and a portion of your lost wages as a result of your work-related injury, a denial may catch you off-guard and cause a great deal of confusion and frustration. It should be comforting to know that a denial is not necessarily the end of the world, and that you may have some options when it comes to getting the compensation that you need and deserve. Read on to learn about a few common workers' comp issues and how to get your claim back on the right track.

When that denial letter does come, you can expect that the reason for the denial will be stated. Common denial reasons include:

1. Injury too insignificant. Workers' comp is there for you for injuries that require professional medical treatment, but not for minor workplace injuries. If your injury can be treated with the contents of most workplace first aid kits, it's likely not bad enough to require a trip to the doctor or hospital. Keep a close eye on any workplace injury; however, you never can tell when a relatively minor cut could blossom into a severe infection, which probably qualifies for workers' comp coverage.

2. Injury not job-related. You are generally only covered for accidents that happen at work, but you should also be covered at off-premises events like a required training session or while driving the company-owned car. Your commute is generally not a covered event. Be sure that you clarify that any off-site injuries were work-related.

3. Injury not reported in a timely manner. Your workers' comp insurance requires that your injury be reported to your supervisor as soon as possible, and that a claim be submitted immediately. There are a couple of extenuating circumstances to keep in mind, however.

a) You were unable to report the injury due to incapacitation. For example, if you are severely injured and hospitalized, you should be able to prove that reporting the accident in a timely manner was not possible.

b) Your injury did not become apparent until some time after the initial event. For example, if your job involves small hand motions on an assembly line, it may take some time for carpal tunnel syndrome to begin to affect you. Once diagnosed with a pertinent injury, you must report it immediately.

Handling Denials

  • Try to avoid panic and instead focus on remedying the issue stated in the letter. Often, a simple phone call to the workers' comp insurance agency will clear up any confusion and allow your claim to be resubmitted. Omissions, typographical errors and other minor mistakes can be cleared up quickly, sometimes with an amended claim form or an attachment.
  • Pay close attention to the timelines in the letter; you may only have a few weeks to appeal the decision. Since workers' comp is a state-run program, you can access the rules for appeals on your state's workers' comp website.
  • Keep in mind that there are often several layers of appeals available, so getting your claim approved may take time some time, but could be ultimately successful.

If you are concerned about the manner in which your workers' comp claim is being handled, contact a workers' comp attorney as soon as possible to help you get the compensation that you need. Click here for info.

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