Denied Workers' Comp? 5 First Steps to Appeal

ISTOCK IMAGE ID 36053710Workers’ compensation is insurance that employers are required to purchase for their employees in most states. Sometimes, larger employers are allowed to self-insure or act as their own insurance companies, and smaller companies may not be required to supply workers’ compensation insurance. When an employee is injured in the workplace, the employee files their claim with the insurance company, who will then pay medical and disability benefits.Unless a company is exempt, employers who do not supply workers’ compensation insurance are subject to fines, criminal prosecution, and civil liability.

Workers’ compensation is in place as a sort of substitute for a lawsuit against your employer. Though an employer can be penalized for not carrying workers’ compensation insurance, your workers’ compensation is not guaranteed to be approved. If your workers’ compensation claim is denied, here are 5 steps to appealing the denial of your claim:

  1. Contact your insurer. You should talk to your insurer before taking any other actions. Sometimes, a workers’ compensation denial can be a simple mistake, such as a missing document. If this is the case, it may be as easy as a few phone calls or emails to set your claim straight.
  2. Ask your insurer to reconsider its decision. Though it sounds simple, it may be this easy. If you have new or additional information regarding your claim, there is a chance your workers’ compensation insurance provider could reconsider its’ initial decision to deny your claim.
  3. Obtain the necessary paperwork for an appeal. Thought the process for appealing a workers’ compensation denial varies between states, the appeals process generally involves an application form to have your denial appealed. In addition, there could be certain deadlines for appealing the denial which you should be aware of.
  4. Gather evidence. The appeals process for a workers’ compensation denial is similar to that of a trial, because you will have to submit evidence to argue your claim. Evidence might include medical records, or any other documents or records relevant to your claim.
  5. Contact an attorney. Like any trial or legal process, appealing a workers’ compensation denial can be very complicated. An experienced attorney can represent you in your appeal hearing, assist with filing the correct paperwork, help gather evidence, and generally guide you through the process and answer any questions you may have.

ISTOCK IMAGE ID 27945366Generally, an employee is barred from simply suing their employer instead of filing for workers’ compensation for a workplace injury. This is because the workers’ compensation system was established to take the place of any potential lawsuits. However, there are some important exceptions where you can sue your employer.

You can sue your employer for a workplace injury if your employer intentionally harmed you, in which case you could bring a suit for an intentional tort. You can also sue if you were harmed at work and you believe the harm was caused by a third party, such as the manufacturer of a faulty piece of equipment.

Finally, you can sue for the wrongful denial or termination of workers’ compensation benefits. You can only appeal your benefits award after the administrative process has been completely exhausted, and all parties have taken every step possible to settle the claim.


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