An on-the-job injury can wreck your health and your career—which is why workers' compensation was designed to provide injured workers with the medical care they need to recover and the financial benefits they need to keep their finances in order.
Unfortunately, the insurance companies don't always make the workers' comp system as easy as it's supposed to be. Claims can be delayed or denied for any number of reasons. If you receive a denial letter regarding your claim, it helps to know what to do next.
1. Find out why your claim was denied.
The denial letter you receive from the insurer should clearly define the reason your claim wasn't allowed. Review the information carefully so that you know exactly what kind of battle you're facing. For example, maybe your employer is claiming you weren't at work when you were injured or the insurance company says that your injury is actually a pre-existing condition. Knowing why you were denied can help you focus your attention as you work to overcome the issue.
2. Determine the deadline for filing an appeal.
Each state is a little different, but you have a very limited time to file an appeal on your denial. Acting quickly is in your best interests because waiting could mean losing your entitlement to benefits permanently. The time limits can be very tight. For example, injured workers in Ohio only have 14 days to file an appeal on a denied claim.
3. Talk to your employer or their insurer.
There's always the possibility that your problem can be resolved quickly. You may be able to clear up the issue with a little additional paperwork or by fixing a mere clerical error. Keep in mind, however, that even if your employer or the insurance company says that they're "working on things" to try to fix your claim, the time limits on filing an appeal still apply.
4. File an appeal and start the dispute resolution process.
Appeals on denied claims are often convoluted and best handled by a workers comp lawyer. An attorney can try to settle your claim through informal mediation and a binding agreement, first. Failing that, your attorney can gather evidence in support of your case and present a persuasive argument to the judge in a formal hearing.
If your claim for benefits has been unfairly delayed or denied and you aren't able to resolve the issue quickly on your own, contact services such as Prediletto, Halpin, Scharnikow & Nelson, P.S.