When your workers' compensation claim is denied, it's important to not lose all hope. You may have a better chance of appealing your claim denial than you think. Not only that, but you might also receive more in compensation than you would have originally received if your claim was originally approved.
Sometimes It Takes a Simple Phone Call
In many cases, a simple phone call by your lawyer will be enough to have your claim approved. For one, involving a lawyer will send the message that you are serious about receiving compensation for your injuries. Also, in many cases, the workers' compensation insurance provider made an honest mistake, such as a clerical error, and will approve your claim after correcting the error on their end.
Complicated Workers' Compensation Claim Denials
Some workers' compensation insurance providers deny claims because they believe they will save more money. However, this sometimes backfires when they discover that you are working with a workers' compensation lawyer and you have evidence to support why your claim is valid. There are several steps you can take to have your claim approved.
You may be able to resolve your workers' compensation claim through mediation. This is when you and the insurance provider engage in negotiations with the help of a third-party mediator. Unlike with arbitration, a mediator does not make a decision themselves. However, they have expertise in workers' compensation law and will be able to guide you through the process.
The Administrative Hearing
Another step is the administrative hearing. At this stage, an administrative judge will look over your claim. You will need to present evidence and you will be allowed to bring witnesses to testify on your behalf. You must also cite relevant law. Because this can be difficult to do for a layman, it's better to hire a workers' compensation lawyer who handles these types of cases all day.
There are also additional options you might have depending on the state in which you reside. A lawyer will be able to help you understand your odds for success.
Filing a Complaint
If you believe that your claim was denied as a result of fraud, your attorney will help you file a complaint with the workers' compensation administrative office. Your complaint will need to be in writing and you will need to supply documents that will support your complaint. Then, you may be able to hold the insurance provider responsible for denying your claim.Share