Denied! Steps to Pursue if Your Workers’ Compensation Claim Doesn’t Go in Your Favor

Injuries may be a common part of life, but they’re certainly not pleasant. Some of the most serious injuries can occur while you’re at work, especially if you work around or with hazardous materials, heavy equipment and machinery, or on ladders and lifts. Thankfully, your company should have a Workers’ Compensation policy to take care of any medical bills you get from treatments, surgeries, medications and therapies. Of course, the Workers’ Comp representative assigned to your case will look at all the factors surrounding your claim to determine whether it has merit. If your claim is denied, don’t give up; you have options to still get the coverage you need and deserve.

Get to the Bottom of the Decision

After you file a Workers’ Compensation claim, you should receive a letter stating the administrator’s decision. If you are denied, the letter should explain what factors led to this unsuccessful claim. Read the letter carefully so you understand the rationale behind this decision. Your company’s human resources team can help you decipher the letter. If you have further questions, don’t hesitate to contact the Workers’ Comp representative. Some of the reasons Workers’ Compensation may deny your claim include the following:

  • Your injury occurred away from work
  • Your injury occurred due to your own unsafe actions
  • You didn’t report the injury on time
  • You didn’t file the claim on time
  • You didn’t provide enough evidence that your employer was responsible for the injury

Appeal the Claim

Just like any other claim decision from your health, auto or homeowner’s insurance, you have the right to appeal a Workers’ Compensation denial. The policy should carefully spell out the steps you need to follow to appeal the ruling. This will include paperwork and documentation with deadlines. Make sure you don’t miss the deadlines, or your challenge may be invalid.

Get Legal Help

If you file an appeal after the original denial but still don’t get the answer you’re looking for, it may be time to enlist the expertise of an attorney. A lawyer that specializes in Workers’ Comp claims will carefully examine all the factors in your case to determine whether your claim has merit. The attorney will represent your best interest, and, if he or she deems you should get coverage, this legal professional will work directly with the Workers’ Compensation administrator.

Don’t get discouraged if you don’t get the help from Workers’ Comp that you feel you deserve. Appealing the claim and getting an attorney on your side are two of the most important responses you can make.

 

Source: Hauppauge, NY Workers Comp Lawyer, Polsky, Shouldice & Rosen, P.C.

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