The last thing a worker injured on the job expects is finding out that their legitimate workers’ compensation claim resulted in a denial of benefits. Unfortunately, claim denials happen more often than most workers in the Treasure Coast region of Florida know.
Does a denial mean that no one believes that you suffered a workplace denial? In a great number of cases, no, it does not mean that no one believes you. It might surprise you to learn that claim denials occur because of administrative or procedural errors. For example, if you wait too long to report the injury to your superiors or to file your workers’ compensation claim, you may receive a denial notice.
Other common reasons for claim denials include the following.
- Injury not covered by workers’ comp (e.g. stress-related injuries may not qualify you for benefits)
- Employer disputes your account of how an injury occurred (while off the clock, while engaging in horseplay, etc.)
- You did not seek a medical opinion or follow the doctor’s orders
- Lack of proof or evidence that an injury is work-related
What can you do when you receive a denial notice?
All employees have the right to appeal the decision when their workers’ compensation claim is denied. The best path to success when appealing the decision is to learn why your claim failed, which should be included in the denial notice. Sometimes, you can resolve the issue simply by speaking with your employer or the workers’ comp insurance carrier.
Other times, a more aggressive approach may yield the best results, especially if an employer attempts to block your valid claim. In these cases, a workers’ compensation attorney can fill an invaluable role in helping you acquire the benefits you deserve. This typically involves investigating the details of the denial and advocating on your behalf when filing an appeal.