Denied Workers’ Comp Claim? Here’s How to Fight Back in 2024

Note: Daryn’s story is a fictional scenario presented to illustrate how a workers’ compensation claim can be denied and appealed. 

If you’ve received a denied workers’ comp claim, don’t be discouraged—this is not necessarily the end of your case.

In 2024, there are still several ways to fight back and appeal the decision. A denial can happen for a variety of reasons, but with the right approach, you may still be able to secure the compensation you deserve.

Understanding why your claim was denied and what legal options are available is critical to successfully appealing a denied workers’ comp claim.

Why Was Your Workers’ Comp Claim Denied?

The first step in dealing with a denied workers’ comp claim is understanding the reason behind the denial. Insurance companies are required to provide a detailed explanation for the denial in the form of a denial letter. Some common reasons for denying a workers’ compensation claim include:

• The injury or illness is excluded from coverage under your state’s workers’ compensation laws.
• The medical report or the cost of treatment does not align with the details of your claim.
• The insurance company or your employer suspects that the claim is fraudulent or exaggerated.
• There is insufficient evidence, or there are no witnesses to the injury or illness, making it difficult to prove in your state.
• Your documentation of the incident or medical care is incomplete or inaccurate.
• The injury or illness wasn’t directly work-related—perhaps it occurred while you were on break, or your employer argues that your symptoms are due to a pre-existing condition.
• The injury resulted from a violation of company policies, such as failure to wear proper protective equipment.
• The injury or illness was not reported within the required time frame—each state has different statutes of limitations.
• You didn’t seek medical attention in a timely manner, which may suggest that the injury wasn’t severe enough to warrant workers’ compensation benefits.

The denial letter will also include a deadline for when you must file an appeal, which is determined by state law. Missing this deadline can further jeopardize your case, so it’s important to act promptly.

Filing an Appeal After a Denied Workers’ Comp Claim

Once you’ve determined the reason for your denied workers’ comp claim, your next step is to file an appeal. It can be helpful to first meet with your employer to see if the denial was the result of a simple miscommunication. However, if the claim was correctly denied, you’ll need to file an appeal with your state’s Workers’ Compensation Commission.

The process of appealing a denied workers’ comp claim involves presenting new evidence, submitting detailed paperwork, and understanding the specific legal requirements in your state.

If your initial appeal is denied by the commission, you may need to take your claim to the court of appeals. This is where having a lawyer can be invaluable, as they can help you gather the necessary evidence, meet legal deadlines, and represent you effectively throughout the appeal process.

What Are Your Next Steps After a Denied Workers’ Comp Claim?

Your next steps following a denied workers’ comp claim depend on the specifics of your case, but we recommend the following actions:

1. Attend all required hearings. Be prepared to present your case to the judge or hearing officer and answer any questions they may have about your injury, the claim, and the denial.
2. Consider negotiating a settlement. Some insurance companies may be willing to negotiate a settlement even after denying the initial claim. Your lawyer can help you determine if this is a viable option in your situation.
3. Explore mediation. Mediation involves a neutral third party helping to resolve disputes. A mediator doesn’t make decisions but facilitates discussions between you and the insurance company to help you reach a resolution more quickly than going through the court system.
4. Keep detailed and organized records. Documentation is key to a successful appeal. Make sure you maintain accurate records of all communications, medical reports, expenses, and any other relevant documents related to your workers’ compensation claim. These records will be essential in building your case during the appeals process.

How We Can Help

Navigating the complexities of a denied workers’ comp claim can be overwhelming, but having the right legal support can make all the difference. A workers’ compensation attorney can help you:

• Save time by handling the legal process on your behalf.
• Represent you in court and during hearings.
• Advocate for your rights as an injured worker.
• Help you build a strong case by gathering necessary evidence and documentation.
• Advise you on the best course of action, whether it’s filing an appeal, negotiating a settlement, or pursuing mediation.
• Communicate with the insurance company and represent your interests during discussions.
• Keep you informed about the latest changes in workers’ compensation laws that could impact your case.

How to Fight Back in 2024

In 2024, workers’ compensation laws continue to evolve to address new workplace challenges and better protect injured employees. A workers’ compensation lawyer can help you stay up to date on the latest regulations and guide you through the appeal process in light of any legal changes.

Whether your denied workers’ comp claim is due to incomplete documentation, a coverage dispute, or a medical issue, understanding your rights and having a solid legal strategy in place is essential for securing the benefits you deserve.

Don’t give up if your claim has been denied. With the right legal support, you can fight back against a denied workers’ comp claim and improve your chances of a successful outcome.

By following the correct steps and seeking professional help, you can navigate the complexities of the appeal process and take control of your workers’ compensation claim..

Daryn’s Story

Daryn works at the Apple Store in a shopping mall, helping customers troubleshoot issues with their devices. One day, while assisting a customer with a heavy desktop computer, Daryn slipped and fell, resulting in a severe back injury. The pain was immediate, and Daryn was unable to continue working that day.

Daryn filed a workers’ compensation claim for his physical injury, hoping to be compensated for the medical expenses and the time he had to take off work for recovery.

His claim was denied because the insurance company argued that the injury was due to a pre-existing condition and that Daryn did not report the incident immediately. He decided to appeal the denial.

He retained a lawyer to prove that the medical bills and lost wages were a direct result of the injury sustained at work and that he did not have any pre-existing back conditions.

In the end, the insurer finally agreed to reimburse him.

Conclusion

Was your workers’ compensation claim denied? If so, we assure you, it is within your right to fight back. The sooner you get a lawyer to appeal the denial, the better.

The Law Offices of Craig L. Cook can help you win your case and get the benefits you deserve. All you have to do is book a free consultation with us, and we will assign an attorney to your case. 

You don’t have to financially suffer from a work-related injury or illness. Contact us today! We are on your side.