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What should you do if your workers' comp claim is denied?

After going through the trouble of filing a workers' compensation claim, your claim may be denied for any number of reasons. It can be a stressful, frustrating process but you have the right to appeal.

Workers' compensation claims are often denied for simple mistakes on forms or because the employer denies fault over certain details included in your report. It may be difficult, but even after a rejection you can still appeal the decision.

Reasons for denial

Your application may have been denied because of any of the following:

  • You missed a deadline
  • Someone else made a mistake while filing the form
  • They contest that the injury wasn't work-related or isn't eligible for compensation
  • They contest you didn't need the treatment you received
  • They contest that you did not use safety equipment correctly
  • They contest you were under the influence of a controlled substance
  • They suggest you injured yourself on purpose

Your employers' insurance may send you to any number of doctors they hire to give their own medical opinion regarding your condition. These medical professionals are employed by the insurers and will likely disagree with your claim to save their employer money. This may also contribute to your denial.

However, their denial does not have to be the final word in your case. It may take someone with legal experience to represent your case and win in an appeal.

After denial

The appeals process may be intimidating, but it is possible to navigate through it by taking the following steps.

  1. File an "Issues Form" to Workers' Compensation Commission and employer's insurance, citing a specific reason you disagree with the decision.
  2. Collect any documents related to your case, including pay stubs, medical records, receipts of any treatment and copies of any medical or legal references or recommendations.
  3. Attend court hearings and proceedings that concludes with who is owed money.

Either party may appeal a second time within 15 days, and this request may be denied, after which you may need to undergo further medical evaluation. The Circuit Court may support or reverse the original decision of the court.

For your financial health, it is important to receive compensation for your injuries in order to pay for your treatment, medical bills, past and future lost wages, back child support payments and any legal expenses incurred during this process.

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Joel L. Katz, L.L.C.
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