Background

My Workers' Compensation Claim Was Denied - Now What?

Posted By Celina || 15-Apr-2015

Many Workers’ Compensation claims are initially denied. When a claim is filed, the Adjuster may call you and gather some information from you to determine if they are going to accept your claim.

It is always best to have an attorney prior to any investigation of your claim by the insurance company, but if you aren’t represented here are 5 things you can do to help protect your rights:

  1. Contact a Workers’ Compensation Attorney – In a workers’ compensation claim, there are important deadlines that must be met. If your claim is denied, then you will have to engage in the Dispute Resolution Process, a workers’ compensation attorney can help to successfully navigate your claim through these waters. Most workers’ compensation attorneys will offer a free initial consultation so call one as soon as possible.
  2. Find out the Basis for Denial – Why was it denied? Is the insurance carrier saying you weren’t injured? Are they saying you are injured but it didn’t happen at work? Are they saying you weren’t an employee of your employer? Are they saying that you have a pre-existing injury? Are they raising an affirmative defense like your injury was not timely reported or that you were intoxicated at the time of the injury? Finding out the basis for denial allows you and / or your attorney to determine what needs to be done next
  3. Continue to get Medical Treatment – When most injured workers’ get a denial of their workers’ compensation claim, they think that they can no longer see a doctor. If the doctor will continue to treat you we encourage you to get the treatment you need. These treatments will help evaluate the extent of your injuries and continue to help you recover for your injury.
  4. Gather Evidence – Once you have a good idea of why your claim was denied, start to gather evidence to support your claim. For example, if your claim is denied because they are saying that you had an old injury, start to gather your medical records from prior to the injury that show all prior injuries were resolved. Or if the insurance carrier is stating that the injury did not happen at work and there were witnesses, talk to the witnesses and ask for written, dated statements to support how your injury happened.
  5. Document, Document, Document!!! – The road to getting your claim resolved can be a long one. So document everything you do and everyone you speak with. Start to keep a log or diary, with dates and information of things that have happened during the claim process, this will be helpful to you and your attorney later.

If your claim has been denied, contact The Recalde Law Firm at 1-855-687-9903 and we will be happy to discuss your options with you.

Categories: Workers Compensation