Denial of Workers' Compensation Claims
Federal and state law mandate that employers provide workers’ compensation insurance to their employees. Workers’ compensation insurance provides benefits in the event of a work-related injury or illness, and is meant to ease losses such as the cost of medical expenses and missing wages. These benefits are due to an employee regardless of who is at fault for the illness or injury, as long as that illness or injury took place at work or was related to work duties.
In spite of these strict laws, some employees’ work compensation claims are denied. At Murphy Law Firm, we have a team of highly experienced work compensation attorneys who represent those from the Great Falls, MT area who are dealing with denial of a workers’ compensation claim. Our attorneys understand workers’ compensation laws and will build a strong case to ensure our clients receive the benefits they are due.
Reasons for Workers’ Compensation Claim Denial
Although employers are required to carry workers’ compensation insurance, insurers may find a reason to deny a work compensation claim. Each claim can cost thousands of dollars in medical expenses and lost wages, and a denied claim results in decreased expenses and liability for the insurer.
Some reasons that are commonly given for a work compensation denial include:
- Missed deadline: A work compensation claim must be filed within a certain amount of time following the onset of the injury or illness. It is important to know the timeframe in which an injury or illness must be reported, because a missed deadline is an easy way for insurers to deny a claim.
- Employer dispute: Another common reason for a work compensation claim is a dispute by the employer. The employer may dispute that the injury or incident ever took place to begin with, or they may deny that the injury or illness is related to work duties. When an employer disputes the claim, the injured party is responsible for providing further evidence to prove their claim.
- Precluded condition: Some workers’ compensation policies preclude certain conditions, or necessitate that an injury or illness must meet a certain degree of severity to qualify for workers’ compensation benefits. It is always a good idea to have a thorough understanding of the worker’s compensation insurance provided by your employer.
These are just some of the more common reasons for denial of a work compensation claim, but there are many others as well. When a work compensation claim is denied, the insurance provider or employer must provide a letter explaining why the claim was denied.
Appealing a Denial
When a work compensation claim is denied, most employees do nothing, and that is what the insurance company is counting on. However, workers have a right to appeal their worker’s compensation claim denial.
As with the initial filing, there are deadlines regarding when an appeal must be filed. The appeals process can also be complicated and often requires a significant amount of evidence. To build the strongest appeals case possible, it is best to work with an experienced work compensation attorney, such as those at our firm. We can examine the details of a workers’ compensation claim to determine the reason for the denial and the best course of action for a successful appeal.
If your workers’ compensation claim has been denied, do not give up hope. Contact us at your earliest convenience to set up a meeting with one of the experienced work compensation lawyers at Murphy Law Firm. We will examine the details of your case and advise you on your best course of legal action.