You just got denied workers’ compensation. What next? This fact leaves you confused with health issues and financial strain. All these take a toll on your mental health, and no one deserves that. 

Workers compensation is a safety net that provides medical and financial support to employees injured at work. However, it’s not always as easy as it sounds. Work compensation insurance companies often deny worker comp claims. 

But if you genuinely deserve it, you shouldn’t relent until you get what you deserve. Keep reading for better insights into why compensation claims get denied and the next point of action when it does. 

Why Do Claims Get Denied?

Common factors that lead to denied workers’ compensation claims are as follows: 

Insufficient Evidence of Work-Related Injury

Evidence is a crucial factor that can swing the pendulum in your favor. When you can’t prove that your injury occurred as a result of your work activities, you may get denied. So, factors like lack of medical documentation, witness statements, etc., may affect this. 

Missed Deadlines

To understand this better, check your state’s statute of limitations because each state has a timeline for reporting such injuries. If you file your claims later than required, you may risk automatic claim denial

Discrepancies in Claim Details

When you file your claim and present evidence, the two need to be consistent. Any inconsistency, even as small as how the injury occurred, may be detrimental to your claims. 

Inadequate Claim Documentation

While filing claims, you need to complete your paperwork diligently. Failure to provide complete or correct details could result in a denial. You should also include all the necessary reports and medical evaluations. 

Immediate Steps After Workers’ Compensation Claims Denial

What should you do immediately after you receive a denial? For one, don’t give up. Denial doesn’t mean you don’t have a chance anymore. Here are some precise steps that can affect your appeal: 

Thorough Review of the Denial Letter

Before doing anything else, examine the denial letter thoroughly. In it, you’ll find details on the appeal, especially the reason for the denial. These details will inform your next line of action. 

Collecting Additional Evidence

If your claim failed due to lack of evidence, you can find more evidence to support your claim. This could include witnesses who experienced the incident, documentation, or extra reports. Ensure you address every issue stated in the denial letter before appealing.

Correcting Discrepancies

Finally, correct any discrepancies in your paperwork and attach necessary documents where required. These little attempts to improve your claims add up eventually. Most importantly, check to confirm that you addressed every issue meticulously. 

How to Appeal a Denied Claim? 

Before securing a workers’ compensation hearing, you need an attorney. Why? Consulting them gives you a better chance of winning your appeal. They have insight into the complexities of workers’ compensation and your legal standing in the case. 

An experienced worker’s comp attorney will strategically plan your appeal to improve your case. They’ll advise you on the most convincing evidence, etc. 

Now, when you secure a hearing, you have to prove two essential things: 

The first one is that the injury happened while you were working.

The second one is causality. You have to be able to prove that the injury caused your current medical condition. 

If you fail to prove either of the two, your chances of winning your appeal are low. 

Proving that an injury occurred on a job is pretty straightforward. You can make a convincing case for yourself with your account of the event and vital witnesses. However, medical causality is challenging to prove without a great attorney and a great doctor. 

You essentially need to convince the court that you didn’t have medical conditions that could be the root cause of your medical issues. Proving this requires several medical reports, X-rays, and previous medical records. 

Final Words

As a worker with a denied claim, we suggest seeking an attorney’s expertise. A lawyer familiar with worker’s comp will understand the whole case better. They can usually guide you on the steps to take while appealing.