(Newswire.net — May 15, 2023) — When an employee is injured while on the job, the workers’ compensation system is designed to provide financial and medical support. Sometimes, a workers’ compensation claim may be denied by the employer or the insurance company. This can be a distressing and complicated situation for the injured worker and their family.
But, there are several steps that employees can take to fight for their rights and appeal the decision. If you believe your workers’ compensation claim has been wrongly denied, you can appeal the decision. Here’s how!
Why Has Your Claim Been Denied?
When it comes to insurance claims, being denied can be incredibly frustrating. In many cases, insurers will issue a letter outlining the reasons for denying a claim. These letters can be filled with confusing jargon and legalese, making it difficult to understand why the claim was denied in the first place.
However, by understanding the most common reasons for claim denial, you can be better prepared if you ever find yourself in this situation. The most common reasons you claim has been denied are likely from one of the following:
- Failure to report your injuries on time: One important reporting requirement for employees who sustain on-the-job injuries is submitting a written report within 30 days of the incident. This report should contain all relevant details about the injury, including the date and time of the incident, the nature of the injury, and the medical treatment received. Failing to comply with this reporting requirement can lead to negative consequences, such as denying benefits.
- Inflicting self-harm: If you purposely cause harm to yourself while at work or participating in work-related tasks, keep in mind that you will not be entitled to receive workers’ compensation benefits. It is important to note that insurers are not required to issue payments in such cases. Any fraud charges can damage your reputation and make it difficult for you to obtain benefits for legitimate injuries in the future.
- Lack of witnesses: It may be easier to establish the incident’s exact time and location with witness accounts. Additionally, proof that the accident happened during work hours is necessary to be able to claim workers’ compensation benefits.
If you have received a claim denial, it means that your insurance company has invalidated your claim and declined to provide coverage for your losses or damages. After a work injury in New York, contact Shulman & Hill for legal assistance.
The Steps to Resolve a Workers’ Compensation Dispute
If you’ve been injured while on the job, knowing your rights for compensation is essential. Disputes can arise when it comes to workers’ compensation claims, but there are steps you can take to resolve them.
The Pre-hearing Conference
When an insurer plans to deny your workers’ compensation claim, they must file a “notice of controversy” with the Workers’ Compensation Board within 25 days of receiving your claim. This notice will trigger the scheduling of a pre-hearing conference where you can submit appropriate documentation and evidence, including a Pre-Hearing Conference Statement.
The board cannot make any definitive decisions regarding your benefits during this conference. However, the conference serves as a way for the administrative law judge to streamline the process and prepare for the formal hearing. This may include resolving issues affecting the final hearing or determining whether you require an independent medical evaluation.
In any case, it’s important to approach this pre-hearing conference with all necessary documentation and evidence to ensure the most favorable outcome for your workers’ comp claim.
A Formal Hearing Conference
The formal hearing is a crucial part of the workers’ compensation process. During this hearing, you and the insurance company will present your cases with the guidance of your attorneys. A judge presides over the hearing and will carefully consider both parties’ arguments and evaluate the evidence provided.
Witnesses, including coworkers and medical professionals, may be called upon to testify, and both parties may submit various evidence to support their positions, like medical records, employment records, and bills. The judge will use this information to determine benefits and other substantive issues related to your claim.
Don’t Miss Your Worker’s Compensation Benefits
Denial of these benefits can have devastating consequences, including financial hardship and reduced access to necessary medical care. Employers may sometimes try to deny or dispute these claims, but employees should not be discouraged.
But, with the help of an experienced workers’ compensation attorney, employees can advocate for their rights and secure the benefits they deserve.