Having your workers’ compensation claim disputed or outright denied is stressful and frustrating, especially when you’re counting on those benefits to pay your bills. Unfortunately, claims are denied all the time, even when they’re valid.
While you do have the option of pursuing an appeal, the process can be draining. If you’re going to fight a disputed workers’ comp claim, here’s what you can do to get your benefits.
- Hire a workers’ compensation lawyer
Sometimes an attorney is the only way to get a disputed claim approved. For instance, if your employer is interfering with your claim, or doesn’t want to cover your medical expenses, a lawyer will help. Even though carrying workers’ comp is a legal requirement for most businesses, some companies don’t carry a policy. Employers should always compensate injured workers fairly, even if they need to cover it out of pocket, but sometimes it doesn’t work out that way. Many employers won’t pay a dime until or unless a lawsuit gives them no choice.
When your employer has a policy, but you’ve been denied, a lawyer can help you prove your case to recover compensation. An experienced attorney will know exactly how to handle the complexities that can lead to denials, like pre-existing injuries, limited documentation, and disputed medical conditions.
- File an appeal promptly
If your workers’ comp claim has been denied, file an appeal quickly. The deadline for filing an appeal varies by state, but you generally have between 30 and 90 days. That’s a really short period of time to appeal, so don’t let life get in the way. Get the proper paperwork from your state’s workers’ compensation board, fill it out completely and accurately, and submit your evidence.
Keep in mind that filing an appeal isn’t an opportunity to present new evidence unless it wasn’t available when you filed your initial claim. It’s also not an opportunity to reword your original arguments. Your appeal will need to point out the errors in the initial decision, so focus your efforts there. This is another reason people hire a workers’ comp attorney – they can spot the errors and explain them clearly in a way that gets appeals approved.
- Get a second opinion
When your injury is being disputed, get a second opinion from an independent physician who has no connection to you or your employer. Results from an unbiased assessment sometimes carry more weight than results from a doctor who has known you all of your life.
- Keep following your doctor’s advice
No matter what’s happening, continue to follow your doctor’s advice. Your claim might be denied today, but next week your appeal could be approved. If you stop treatment for any length of time, that could come back to hurt you.
Even after you’ve finished receiving all of your benefits, if the insurance company finds out you gave up medical treatment, they might use that against you to reverse your claim and require you to pay back some or all of the benefits you received. Thousands of people commit workers’ comp fraud every year, and many are convicted. Even if your injury is valid, receiving benefits when you didn’t receive medical care is considered fraud.
- Ask your doctor for a detailed report
For some injuries, a general doctor’s report is enough. However, if your claim was denied, it won’t hurt to get a detailed report to see if that changes the outcome. Whether you submit the report with your appeal or use the information when presenting your case, a detailed report can become a key piece of evidence.
- Prepare for your hearing
Once you appeal, you’ll get a date for a hearing where a judge will listen to your arguments and make a final decision. Start compiling all of your important documents, like medical records, witness statements, communications with your employer, and anything else relevant to your case. Being organized will make a positive impression on the judge.
During your hearing, you’ll be asked to explain how you became injured, what led to the accident, and how it has impacted your life. Prepare your answers ahead of time by practicing the conversation out loud.
Stand up for your rights
If your workers’ compensation claim was denied, you’re making the right choice to appeal. However, if you feel overwhelmed, don’t hesitate to seek legal assistance. Working with a professional to present a strong case during your hearing will give you the best chance at getting a favorable outcome.
