Workers Compensation Claim Denials: Get The 411
If you suffer a severe injury on the job, then one of your main resources is filing a claim with the workers compensation program in your state. Unfortunately, it's quite possible that your claim will be denied if it's challenged by your employer or you do not follow proper procedures. Here is a closer look at the important issue of claim denials.
Time Limits
A common cause of a claim being denied is that the worker does not file in a timely manner. Every state has a time limit during which you must file with the workers compensation office. The limit varies by state, but generally is at least one year after the injuries occurs. Another time restriction, however, offers you much less time to act. You must notify your employer of the injury within 30 to 45 days of the accident in most cases. Missing either of these deadlines could result in a claim denial.
Firing
If you are injured, it's crucial to notify your employer and file a claim as soon as possible. One reason, of course, is to avoid missing the deadline, but another reason is the possibility the you might be fired before you start the worker's compensation process. If you are fired from your job first, you decrease your chances of having your claim accepted. Your employer or his insurer may be able to successfully allege that your injury occurred after you were terminated.
Severity
Another frequently seen reason for the denial of a claim is that the employer disputes the severity of your injury. If the employer's or insurance company's doctor convinces the workers compensation board that your injuries do not prevent you from performing your duties, your claim could be denied. If this happens, then you may need to have a medical specialist review your case and offer the worker's compensation officials a more detailed analysis of your injuries.
Appeal
Although there are various reasons that your claim may be denied, that is not necessarily the end of the story. You have the right to appeal a denial. Like the time restrictions on filing and notifying your employer, the appeals process varies from state to state.
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