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What to Do if My Workers’ Compensation Claim Is Denied?

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Why Would Workers Comp Be Denied

 

Sometimes workers’ compensation is denied to the employee who suffered an injury at the workplace. There are certain reasons a compensation claim may be rejected. In this article, we will discuss what happens if workers comp is denied to you as an employee. We will touch on the questions about whether can workers’ comp deny a claim, whether can workers’ comp deny a second opinion, and why would a workers’ comp claim be denied. We will also discuss the solutions when workers’ compensation is denied.
Find out now and explore your options with the help of workers’ compensation attorneys.

Reasons for Workers’ Compensation Claims Denial

Your workers’ comp claim denied now, what is next? First, you have to look into the reasons why your claim was denied. There are some common reasons for workers compensation denial:

  • Incomplete, irrelevant, or wrong claim paperwork by the employee, insurance company, or the employer.
  • Claims based on fraud.
  • Employer’s negligence in the accident.
  • The employee did not perform the pre-requisite conditions before filing the claim i.e. receiving medical treatment from an approved medical practitioner, informing the employer about the injury within the prescribed time, or bringing the claim within the mentioned limitation.
  • The employee received the injury due to a practical joke, intoxication, recklessness, etc. 
  • The injury did not result from an accident but is present due to some pre-existing medical condition.
  • Not having a workers’ compensation lawyer is a contributory reason for your denied workers compensation because they help you ensure the above-mentioned mistakes don’t happen. If such mistakes happen and it results in workers compensation denied claims, they are experienced to tackle each reason with appropriate legal solutions. 

How to Appeal a Workers’ Compensation Denial?

In Kansas City, Missouri, if you are an employee who has suffered a workplace injury and are facing workers comp denial issues, you have the right to appeal such workers compensation denied to you. Here are the steps to appeal a denied workers compensation claim: 

  • The first step is to understand the causes why your claim is denied. The reasons stated above are some of the few causes of your claim being denied. 
  • The second step is to communicate the denial of your claim to your insurance company and employer and consult what steps to take. Sometimes, the employer or insurance company provides additional information and documentation that can facilitate legitimatizing and strengthening your claim. 
  • The third step is to consult a workers’ compensation lawyer to weigh your options in your special circumstances according to the compensation laws in Kansas City, Missouri. 
  • The fourth step is to file a claim with the Kansas Division of Workers’ Compensation if the insurance company and your employer cannot resolve your issue. This can be done by filling out the necessary forms available on the website of the Kansas Division of Workers’ Compensation, or they can be furnished from their office. 
  • The last step is to file the appeal with the assistance of an expert workers’ compensation attorney along with the supporting documents and submit it to the Kansas Division of Workers’ Compensation. Make sure you understand all the prerequisites of an appeal before you submit your appeal paper.

What are the Chances of Winning a Workers’ Comp Appeal?

The chances of winning a workers’ comp appeal depend on how your present your case to the Compensation Division. Make sure you have all relevant supporting documents such as evidence, medical reports, bills, prescription of medicines, estimated recovery time opinion by the approved medical practitioner, CCTV footage or images of the accident (if available), and an appeal petition in place when you submit your appeal. Make sure to engage an expert workers’ compensation attorney to draft a legally sound and tailor-made appeal so there are no legal mishaps. Consult with your injury lawyer about all the supporting documents before you submit the appeal.

Mistakes to Avoid During the Workers’ Comp Appeals Process

Mistakes can be avoided during the worker’s compensation appeal process by ensuring that: 

  • Deadlines are not ignored or missed. Most employees get relaxed after filing an appeal and do not catch up on hearing dates and deadlines to provide additional relevant documents that are requested during appeal proceedings. Keeping yourself informed and vigilant is the first step in the right direction. 
  • You don’t proceed without a legal representative. Hire an experienced workers’ compensation lawyer to represent you before at the appropriate forums. These lawyers are skilled in their field and increase your chances of winning an appeal. They have the relevant expertise and knowledge of compensation laws, which are generally complex for the layman, and this skill can play to your advantage. Hiring a workers’ compensation lawyer also ensures you don’t make any legal mishaps that can affect the outcome of your appeal.
  • Medical treatment is regularly received by you. If you just ignore the prescribed medical procedures and neglect the medicines you should be taking, it can adversely affect your appeal and make a negative impression on the outcome of the decision. 
  • You don’t disclose your information to a third party or on social media platforms to get public sympathy. 
  • You provide all the additional supporting documents timely and attend the proceedings punctually.

Conclusion 

To conclude, if your workers’ compensation claim has been denied, do not worry. You have the option to appeal that decision. With the help of an experienced workers compensation lawyer, you can prevent making mistakes in the initial claim and win the compensation you deserve. However, if your initial workers’ compensation claim is denied, an experienced lawyer can help you fix a denied workers’ compensation claim or help you win in the appeal process.

Jason Royce Allen

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