By Admin 
Did you know that US employers reported approximately 1.5 million work-related injury and illness cases in 2023? About 90% of these cases are injuries, with the remaining 10% being illnesses.
Workplace injuries can have profound and lasting effects on workers, impacting their physical, emotional, and financial well-being. Injured employees can file for worker’s compensation, which they can use to pay bills and other medical expenses.
But what happens if the claim gets denied? Keep in mind, a denial does not signify the end of your journey; you still have the opportunity to contest the decision. You should carefully review the denial letter to understand the specific reasons your claim was rejected.
Or you can seek help from a denied workers’ compensation benefits lawyer who can assist you with the process. Here are the next steps you should take to keep you on track:
Common Reasons for Workers’ Comp Claim Denials
Experiencing denial after filing a workers’ compensation claim hurts, but it’s important to be logical and understand why it happened.
If you failed to report the injury immediately, the insurer might deem it invalid. If there isn’t enough documentation, denial is also possible; be sure to submit all required forms and medical records. Another ground for denial might also be the lack of medical evidence linking the injury with the employment. If your employer fights the claim, extra factors can come into play.
If you think that it’s too overwhelming for you to process the claim on your own, you can seek the assistance of a workers’ compensation attorney near you who can process the appeal right away.
Understanding the Appeals Process
When your claim gets rejected, you probably want to contest it. Understand why your claim was denied and research the appeals process. The laws vary considerably from state to state. Typically, filing a notice of appeal necessitates specific forms and deadlines.
You will need to explain why you feel the denial was not warranted. Keep copies of everything in order that pertains to your case for reference.
Consider contacting an attorney if matters become complicated. He could give you valuable insights and help encourage you in winning your appeal.
Gathering Evidence to Support Your Case
Once you scanned the denial letter with an understanding of the appeal procedure, evidence-gathering became the next step to prove your case. Start with the medical records, physician notes, treatment protocols, and test results relating to your condition. Prove your injuries and how workplaces are involved.
Collect witness statements from any coworkers who saw the incident or can verify your condition. Keep a daily record of your symptoms and any medical appointments you have had.
Photographs of the accident scene or any injuries may also be needed if possible. Again, gather all correspondence with your employer or the insurance company. All this evidence will help prove that your claim is legitimate and will aid your cause in the appeal.
Tips for Strengthening Your Appeal
To present the appeal, an organized packet of evidence will be the most convincing. First, you should read the letter of denial to find out why it was denied.
Gather related documents under your name: medical records, witness statements, incident reports, etc. Make sure that the evidence directly addresses the issue of denial.
Create a timeline of the events leading to your injury. It generates context that helps your case in terms of how the injury occurred.
When you appeal, it is short and factual without that overtly emotional touch. Make your argument clear and buttress it with evidence you’ve collected.
Ask a close colleague or friend to look over your appeal for you in terms of clarity and coherence before you submit it.
When to Seek Legal Assistance
There are times when it would help your case to know when it is time to seek help from a lawyer during a complication related to a denied workers’ compensation claim. If your appeal fails, hire a workers’ comp lawyer to explain your options and clarify legal terms.
If you have aggressive moves from the insurance company or if the denial itself rests on very complicated legal issues, then that is the time to seek help. A lawyer can gather necessary evidence, build your case, and represent you at hearings.
Taking prompt and informed action can make a significant difference in the outcome of your case.