What Happens if my Workers’ Compensation Claim is Denied?

What Happens if my Workers’ Compensation Claim is Denied?

When an employee is injured at work, it is possible for them to recover workers’ compensation. This exists so that the individual can receive benefits as coverage for a variety of damages while they heal. However, receiving workers’ compensation is not always easy. It is possible for a claim to be denied at any point during the process. Continue reading below to learn more about what you can do in these situations. 

Why Can a Claim be Denied?

There are a variety of reasons as to why a person’s claim for workers’ compensation may be denied. This can include the following:

  • The injury was not reported in time. Each state has different laws regarding the amount of time a person has to report the incident and injury to an employer in order to receive benefits.
  • The insurance claim was not filed in time. This can lead to the denial of the claim.
  • The individual’s employer successfully disputed the claim. This may be if they claim the injuries happened as a result of horseplay or the person was performing non-work-related tasks when they became injured.
  • The injury is not compensable. For example, a stress related injury can be difficult for a person to prove in court. 
  • The injured party did not receive medical treatment. If a doctor is not seen, an employer can claim the individual was not truly injured.
  • If you cannot prove that the injury occurred at work and is work-related, the claim may be denied. 

What do I do if my Claim is Denied?

When a workers’ compensation claim is denied, the injured party will most likely receive a letter from the insurance company or their employer stating so. In addition to this, the letter will also acknowledge a deadline for an appeal if the individual wishes to do so. In the event that a resolution cannot be reached between the injured party and their employer or insurance carrier, an appeal should be filed immediately. During this time, they can work with an attorney to gather evidence relating to their case that can prove they deserve workers’ compensation. This can include evidence that shows the claim was filed properly, the injury is work-related, and that they received proper medical care. After a thorough investigation, the appeal can be drafted and presented to the court. 

Contact

If you have become the victim of an on the job injury, it may be beneficial to speak with an attorney and the doctor that is treating you to determine how to make the process as easy as possible. AllianceMeds understands that a workplace accident can be challenging and is here to help. We will deliver your medication to your door using overnight delivery and cover any out of pocket expenses that may arise. If you have any questions about how we can help, contact AllianceMeds today.