Steps You Can Take if Your Workers’ Compensation Claim Was Denied

Steps You if Your Workers’ Compensation Claim Was Denied

Getting injured is never a pleasant experience. Getting injured while at work can be an even more complicated situation. Depending on the circumstances, you may be entitled to workers’ compensation coverage. If you recently got hurt while on the job, you should file a claim. Doing so could cover any medical costs you incur and even pay for the time you have to miss at work. Unfortunately, some claims are denied. If this happens to you, there are ways to appeal your case and still get the help you need. 

An Understanding of Workers’ Compensation

Workers’ compensation insurance coverage pays for medical costs when someone is hurt at work. These include paying for medical treatment, medication, hospital stays, surgeries, and doctor’s office visits. The coverage can also replace income when the injury renders the person unable to continue doing his or her duties. To file a claim, the employee must first report the injury to his or her supervisor or human resources representative. Once the claim is filed, the employee may not sue the employer for negligence. 

What Qualifies?

Not all workplace injuries will qualify for workers’ compensation coverage. The injury must not be a result of horseplay or failing to follow safety guidelines. The individual must be engaged in normal work duties during approved hours and activities. The incident does not necessarily have to occur in a workplace facility as long as the employee was performing his or her expected tasks. 

Filing an Appeal

If your workers’ compensation claim is denied, you should file an appeal with the insurance company. A representative from your company or from the insurance company should guide you through this process. You should be prepared to explain why you believe the denial was the wrong decision and why your claim should be valid. The appeals process can take several weeks. A different claims team member will review your appeal.

Hire an Attorney

If your appeal isn’t successful, it may be time to take legal action. If you are convinced that you still have a case, talk to a personal injury attorney or a lawyer who specializes in workers’ compensation cases. Your attorney will thoroughly review the situation and evaluate whether your appeals have merit. Attorneys have experience negotiating with insurance companies and uncovering the reasons why the claim was denied.

Do not get discouraged if workers’ compensation denies your claim. There are actions you can take to overturn the decision. Contact an experienced attorney, like a workers’ compensation attorney Brooklyn from Polsky, Shouldice, & Rosen, P.C., today.