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What To Do When Your Worker's Compensation Is Denied

6 July 2016

Alexis Garcia

Dealing with a denied worker's compensation claim can be frustrating. But fortunately, not all denials are set in stone, and there are times in which an appeal can work in your favor. If you feel like you have a right to your benefits, here's what to do once you receive the denial letter.

Examine the Reason For Denial

Most states have a specific time frame in which you must notify others of your injury, and claims are sometimes denied for not reporting the injury quickly enough. In Colorado, you have to report your injury in writing to your employer within four working days of it occurring. In California, you have 30 days to provide a written report of the injury and one year to file a DWC-1 form. This form is simply handed to your employer who then gives it to the worker's compensation insurance company.

Other reasons for denial include a contention that your injuries did not occur on the job, that they were a result of a pre-existing condition, or the doctor examining you may claim that there was no evidence of a disability resulting from injuries.

Knowing why your claim was denied will determine what's next in fighting or appealing the denial.

Consult with a Worker's Compensation Attorney

Consulting with a workers comp lawyer that is familiar with your state can help tremendously in several ways. They can guide you through unfamiliar territory, and they should know some loopholes in the following areas that may work in your favor.

Untimely claim. When facing a situation in which your claim was denied by not filing in a timely manner, you should know that there are some gray areas here that could help your case. If you can somehow show that your employer was aware of a possible injury—in an informal way—you may be able to fight the denial.

For instance, suppose you work as a veterinary technician in the state of California, and months before filing your claim, you told your boss that your wrist began hurting after restraining a thrashing dog earlier in the day. Your attorney could argue that the verbal notice you gave counted as letting your employer know.

Also, if you work in Colorado and failed to provide the necessary report within four days, you may be subject to a penalty instead of a denial. This is something that could be brought up during an appeal.

Missing form. Sometimes, forms are filled with language that makes them difficult to understand. And often, a denial letter is sent out simply because a particular form is missing that you weren't aware was even required. An attorney can work on your behalf to contact the insurance company or your physician to procure the needed document and send it in.

Injury not work-related. For situations in which you are told that the injury did not occur at work, some co-workers may be willing to step forward as witnesses, or an attorney may be able to summon other forms of evidence that could help you win your claim.

For example, in 2012, an Atlantic City woman was leaving work when she sustained injuries in a car accident. Her claim was initially denied when the casino where she worked stated she was off company property. However, surveillance cameras later revealed that one foot of her rear bumper was still in the casino parking garage, and as a result, she was still at her place of employment when the accident occurred. She ultimately won her appeal when a judge with the state Division of Worker's Compensation ruled in her favor.  

No injuries found. If your claim is denied because the doctor did not find any injuries, or if they weren't serious enough to warrant a disability claim, there are some situations in which an appeal may work, and your attorney can generally make this determination.

For example, in some states, you're allowed to pre-choose a doctor should you suffer an injury at work. If your employer failed to notify you of this right, or if any other rules are broken, such as failure to display a poster of your worker's compensation rights, then this could work in your favor.

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