It’s not unusual for workers’ compensation claims to face initial denials. Insurance companies often prioritize their financial interests, aiming to minimize payouts while maximizing premium collections. Therefore, your claim might be denied in an attempt to make you concede defeat. However, there could be other factors contributing to the denial of your claim.
Read on to learn about some of the reasons a claim might be denied and then contact PLBH at (800) 435-7542 if you would like a consultation with an employment law attorney.
Understanding Your Denial Letter
You should have received a denial letter by mail, detailing the reasons for rejecting your claim. This typically includes not fulfilling specific eligibility criteria.
Common Grounds for Claim Denial
Here we explore some common reasons for the denial of workers’ compensation claims. Each of these can provide insight into why your claim may have been refused, but they are not exhaustive.
Late Reporting or Filing
One of the major reasons for denial could be the tardiness in reporting the injury or filing the claim. Each state has specific time limits for these processes, and not adhering to these could lead to claim denial.
Employer Disputes Claim
At times, employers may dispute a claim, arguing that the injury did not occur in the workplace or during working hours. This contention could cause an initial denial of your claim.
Non-compensable Injury
Some injuries might not be covered under workers’ compensation insurance. If your injury falls into a non-compensable category, this could be a reason for claim denial.
Lack of Medical Treatment
If you haven’t sought medical treatment following your injury, the insurance company might view your claim skeptically, resulting in denial.
Insufficient Proof of Work-related Injury
To approve your claim, the insurance company needs substantial evidence that your injury is work-related. A lack of sufficient proof could lead to denial.
Appealing a Denied Claim
Once you understand the grounds for your claim denial, you can challenge it if the denial was unjust. Your denial letter should specify a deadline for appeal, which depends on your state’s regulations. This is where professional legal assistance can prove invaluable.
An experienced workers’ compensation lawyer can scrutinize your case’s specifics, providing an informed opinion on the likelihood of a successful appeal. Appeals can be intricate, especially for workers’ compensation cases, and are best handled by proficient legal professionals.
How an Can Assist
If you’re considering appealing a denial, PLBH is here to support you. With over three decades of legal experience, we are dedicated to aiding injured workers secure the benefits they rightfully deserve. Contact us at (800) 435-7542 to discuss your case. Let us help you in your quest for justice.