Suffering injury in the workplace is not reserved only for those who work in an environment with heavy equipment or machinery. Products can malfunction, accidents happen, and people are injured in even the most mundane office situations every day. This is why employers are usually required to carry workers’ compensation coverage for their employees. This type of insurance is designed to help people who are injured at work receive compensation to help pay medical bills and lost wages incurred while they are out of work due to recovery time.
When a workers’ compensation claim is denied, it leaves people in an unpredictable and difficult situation. The denial of a workers’ comp claim is not necessarily the end of the story, however. It’s imperative that both employers and their employees understand what steps to take following a workers’ compensation claim denial.
Reasons for Workers’ Compensation Claim Denials
Figuring out why a claim was denied helps you figure out what to do when you appeal the decision to deny the claim. Some of the most common reasons include the following:
- An injury occurred and was not reported in a reasonable amount of time as dictated by individual state laws.
- The claim was not filed in a reasonable time, which is usually anywhere between 30 and 90 days of the injury taking place.
- The employer chose to dispute the claim by stating the accident did not occur in the workplace or for any reason the business is responsible for.
- Injuries are not physical. Mental and emotional injuries such as stress from work are not covered by worker’s compensation in all states.
- Medical treatment was not necessary or sought.
- Lack of evidence the injury occurred at work.
Once you know the reason behind the denial, you have more to work with as you file your dispute. This could help you provide further evidence that you did not think to include the first time you filed a claim. It’s not a guarantee your claim will be approved the second time around, but it’s helpful to know you have options.
The Appeal Process
One of the best things anyone can do for their case is hiring workers’ compensation lawyers Long Island trusts to handle the case when it gets this far. The appeals process can take weeks, months, or longer depending on the severity of the injury, the lack of evidence, and the amount of employer cooperation. An attorney may help make the process a little less stressful with their knowledge of the law and the statutes that define this particular situation.
When it’s time to file your appeal, you have only 30 days to do so in most states. Depending on where you live, the process of appealing a workers’ comp denial is a long process. It’s recommended you speak to your employer to see what the issue might be and work together — provided the denial did not come from their own dispute of your claims. Working together may increase your chances of finding approval of your appeal.
Due to the complicated nature of the appeals process, a workers’ compensation lawyer is useful when it comes to understanding legal jargon, understanding what’s required of you, and filing paperwork and further motions on time. It’s a stressful situation to recover from without the legal battle of a workers’ comp appeal, and you deserve a chance to recover from your injuries without facing this kind of stress in addition to your injuries.
Thanks to our friends and contributors from Polsky, Shouldice, & Rosen P.C. for their insight into workers compensation claims.