What to Do Following an Unfair Workers’ Compensation Denial

Workers’ compensation insurance is a program that was created to reduce the number of lawsuits filed by injured employees in the United States, while still allowing them to get their medical bills covered.

If you’ve been injured at work, with few exceptions, you’re required to file a workers’ compensation claim. However, sometimes valid claims are denied, and other times, employers aren’t covered. Although most employers are required to carry a policy, some choose to skip the legal requirement. 

In any case, if your claim has been denied, or you can’t file a claim because your employer isn’t covered, here’s what you need to know. 

1. You can hire a lawyer to fight for you

Whether your claim was denied, or your employer isn’t covered, a workers’ compensation lawyer can help you get the money you deserve. 

Where unfair claim denials are concerned, insurance companies are banking on you not knowing your rights or how to call them out on their fraudulent decision. An attorney will know exactly how to handle this situation, and won’t hesitate to show the insurance company their error. Most of the time, if a claim is truly valid, hiring a lawyer is all you need to do to get paid.

If your employer doesn’t carry workers’ compensation insurance, you have the right to hire a lawyer and sue for damages. Since not all employers are required to carry this insurance, you might only get compensated for direct medical bills. The legal requirements for carrying coverage differ by state. However, if your employer is not exempt, they’re breaking the law by not having coverage, and in that case, you may be able to win punitive damages as well.

2. You can appeal a claim denial

If your workers’ compensation claim has been denied, you have the right to appeal that denial. If you don’t have a valid case, your appeal will be rejected pretty fast, however, many people have successfully won their appeals.

Claims are commonly denied for the following reasons:

• The injury appears to be non-work-related. A denial may occur if it looks like your injury was caused by a pre-existing condition, or if it happened outside of work.
• Your employer disputes the claim. Your employer has a say in the matter, and may tell the insurance company that your injury was caused by a disqualifying factor, like horseplay, or they may say the injury didn’t happen at work.
• The injury wasn’t reported. You have a time limit for reporting an injury to your employer, and if you don’t make the deadline, your claim will be denied.
• Poor documentation. You need to prove the extent of your injury, and poor documentation can result in a denial.
• You didn’t seek medical care. You can’t get compensated for an injury you can’t prove happened, and if you don’t get medical care, it will look like you aren’t hurt. Workers’ comp isn’t just free money for being injured – it’s for paying your medical bills.
• Your injury doesn’t qualify. With the exception of California, most states don’t cover stress-related injuries, among others.

When you plan to file an appeal, do so immediately. There is a tight deadline for appeals, and once that window has passed, you lose the chance to file an appeal.

3. Accept the reality of your situation

It’s possible that both your claim and appeal will be denied. If you talk to an attorney and they say the insurance company has a valid reason to reject your appeal, all you can do is accept the reality of that denial. It’s unfortunate sometimes, especially if it was a simple mistake on your part, but you’ll need to go with the flow because, at that point, you have no other options.

Hopefully, you’ll get your medical bills taken care of, but if not, you do have the option of debt consolidation, debt negotiation, or even bankruptcy. There are companies that specialize in negotiating down medical debt, so it’s worth checking out. However, you’ll need to meet a certain threshold for it to be worth their time. The same goes for debt consolidation.

Always fight until the end

No matter your situation, if you’ve been denied, it’s always worth appealing and discussing your case with a lawyer. Don’t give up until you’ve taken things as far as possible so you know for certain that you’ve explored and exhausted all of your options.

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