Did your workers’ compensation claim get denied? Some can relate. You can stand up for yourself and get the money you need. Numerous clients have contacted Chester workers’ compensation lawyer to discuss their unsuccessful workers’ compensation claims. Calls like this typically originate from employees wrongly refused benefits after suffering a lawful injury or doing something irrelevant to their job.
Why Workers’ Comp Claims May Be Denied
The following are examples of the most typical causes for the denial of workers’ compensation claims:
- It took some time for the injury to be reported.
- The deadline for claim submission has passed.
- The employer voiced claim concerns.
- Damage from this recurrence is not possible.
- The employee refused to seek any medical treatment
- There isn’t enough proof that the harm really happened.
Steps to Take if Your Claim Is Denied
Your workers’ compensation claim is not over just because you received a refusal. If you can prove that the judgment was made incorrectly, you have the right to appeal it under the law. To increase the likelihood of a successful appeal, follow these steps:
- Determine the Denial Reason(s)
Find out why your claim was denied first. These grounds are detailed in the letter of denial. Read the letter thoroughly, make note of the reasons, and do your best to comprehend the reasoning behind the rejection.
- Keep an Open line of Communication With Your Employer
Misunderstandings or clerical mistakes might lead to the rejection of a claim. Sometimes, all it takes to resolve the issue is a meeting with the employer. To bolster your case, you could also get fresh evidence or information.
- Collect Additional Evidence
Gather further proof to refute the insurance company’s grounds for denying your claim. Gathering relevant medical records, such as diagnostic tests, doctor’s notes, and other relevant information, may be necessary to establish a causal relationship between your injury or illness and your job duties or potential dangers. Gathering statements from coworkers who witnessed the incident or accident and are prepared to testify on your behalf may also be part of the process.
- File an Appeal
You can appeal the decision if your Illinois workers’ compensation claim has been denied. Contesting the refusal decision directly with the insurer is the first step in the appeal procedure. Sending the insurer a thorough appeal letter with relevant proof will do the trick.
You can formally appeal to the compensation commission of your state if the insurance company refuses to rethink its judgment. The next step is to have your case heard in arbitration, where an impartial third party will carefully review the facts and decide whether to overturn or confirm the insurer’s decision. You can challenge the arbitrator’s decision in favor of the insurer by submitting a Petition for Review to the commission before the deadline.
When is the need to hire a worker’s compensation lawyer?
An expert workers’ compensation attorney should be consulted whenever a workers’ compensation claim is refused. Employing legal representation greatly improves the odds of a workers’ compensation hearing and subsequent appeal victory for injured employees whose claims have been denied. Workers’ compensation lawyers have extensive knowledge of the claims and appeals procedures, which is why they are so effective. Insurance companies try to deny workers’ compensation based on we are familiar with, and we know how to win by arguing our clients’ points to the courts.
Conclusion
Although it may be discouraging to have your workers’ compensation claim refused, it is important to remember that you do have options. You can significantly increase your chances of winning an appeal by investigating the grounds for rejection and consulting an attorney.
