Steps To Take After Your Workers Compensation Claim Is Denied

Many people hope for a smooth process when filing for workers compensation, especially when dealing with the stress of an injury. Yet, sometimes, the unexpected happens: your claim gets denied. But don't lose hope! This is not the end of the road. Use this guide on the next steps to take if you find yourself in this situation.

Understand the Reason for Denial

To address the issue effectively, first grasp its root cause. Gaining clarity on the problem is the initial step towards its resolution:

• Read the Denial Letter: Your employer or the insurance company will send you a letter detailing why your claim was denied. This is your roadmap for moving forward.
• Know the Common Reasons: Claims can be denied due to missed deadlines, doubts about the injury occurring at work, or missing medical information.

Understanding the reason sets the stage for your next moves, ensuring you address the exact issues highlighted.

Speak With Your Employer

Maintaining transparent dialogue is essential. Effective communication can pave the way for resolution:

• Schedule a Meeting: Sometimes, misunderstandings or administrative errors can lead to a denial. Discussing the issue might clear things up.
• Gather Information: Understand your employer's perspective. They might have information or documentation that you're unaware of.

By keeping the lines of communication open, you might find a resolution without further steps.

Seek Medical Documentation

In this process, having strong evidence is crucial. It acts as your most reliable ally in supporting your claim:

• Visit Your Doctor: Ensure all your injuries are thoroughly documented. This might mean undergoing additional tests or evaluations.
• Secure Records: Obtain copies of all your medical records related to the injury. Ensure they clearly indicate the injuries resulted from a workplace incident.

With robust medical documentation, you can solidify your claim's legitimacy.

Consider Hiring an Attorney

If uncertainties arise, seeking professional assistance is wise. Experts can provide the direction you need:

• Find a Specialist: Hire an attorney knowledgeable in workers compensation. They'll be familiar with the intricacies of the process.
• Schedule an Initial Consultation: Many attorneys offer free initial consultations. Use this opportunity to gauge if they're the right fit for your case.

Having a seasoned expert on your side can dramatically increase your chances of a favorable outcome.

File an Appeal

Should other methods prove unsuccessful, you retain the option to contest the decision. Exercising this right allows for a reevaluation of your case:

• Understand the Process: Depending on your state, the appeals process might differ. Familiarize yourself with local procedures.
• Act Promptly: There are often strict deadlines for appeals. Ensure you act quickly to avoid missing your window.

An appeal offers a second chance, allowing another review of your claim with the additional information you provide.

Document Every Communication

Maintaining a clear record is essential for clarity and evidence:

• Log Conversations: Every time you speak with your employer, insurance representative, or attorney, jot down the date, time, and key points discussed.
• Save Written Communications: Preserve all emails, letters, and notices related to your claim. They can serve as evidence if discrepancies arise.
• Note Medical Appointments: Document every medical visit, its purpose, and any advice or prognosis given. This can help validate your injury and its connection to the workplace.

Keeping a meticulous record ensures you have a timeline and proof of all interactions related to your claim.

Having your workers compensation claim denied can be disheartening, but remember that you have options and resources available. Follow the steps above and be persistent in your pursuit of justice. If you need assistance or guidance in navigating this process, reach out to Gilbert, Blaszcyk & Milburn, LLP. We're here to help ensure you get the compensation you rightfully deserve.