Personal Injury Lawyer

Most employers are required by law to purchase workers’ compensation insurance to cover their employees in the case of a work-related injury or illness. Having to file a workers’ compensation claim as an employee can be a complicated issue that may or may not be accepted by the insurance company, depending on the incident you were involved in and whether or not there is sufficient evidence to prove that it was in fact a work-related incident.

After you’ve notified your employer of the accident, filled out the proper forms, submitted your claim to the insurance company, and they’ve denied your claim, the next steps you take are crucial in determining whether you’ll be able to obtain the coverage you need to fully cover your increasing medical bills and at least some of your lost wages if you’re unable to work for a period of time.

It’s important to note that all states have different forms and deadlines for workers’ comp, and it is necessary to follow all of the laws to ensure the insurance company cannot find any reason to deny your claim.

What Next?

Just because the insurance company denies your claim does not mean that it all ends there. If your claim has been denied, it is recommended that you work with a workers’ compensation attorney, like a workers’ compensation lawyer in Green Bay, WI, to assist you in the dispute and appeal process.

The insurance company will usually send a letter explaining why your claim was denied and include instructions on how to do the appeal. You must complete this process in the time allotted, often between 30 and 90 days since the denial. Just know that missing this deadline may end your case immediately and leave you with no benefits.

If you think the reason for your denial was due to system error, fraud, or another unusual mistake by the insurance company, you can file a formal complaint with them, which could impact your settlement amount if your complaint is found to be legitimate.

Reopen Your Claim

After you appeal a denial, you will have to reopen the workers’ comp claim, which can be done between three to seven years (depending on where you live) after your claim’s denial. You must have a concrete reason to reopen the claim, such as:

• Additional evidence is provided to further prove the legitimacy of your claim
• More evidence is given that shows the inadequacy of your original compensation
• An error or fraud is discovered within the insurance company

Each state has different forms you need to fill out to officially reopen your case. If your appeal and case reopening go according to plan and the insurance company accepts your claim, there is a chance they will try to award you less than what you need. This is when you’ll want to consult with an experienced workers’ comp lawyer, as they can help improve your chances of acquiring full coverage.

Thanks to Hickey & Turim Attorneys at Law for their insight into what to do with a denied workers’ compensation claim.