What To Do If My Workers Compensation Claim is Denied?

You hurt yourself at work a few weeks ago. And did everything right. You told your supervisor about the accident. You completed an accident report. You sought medical care and turned over your work restriction note to your boss.
But now you’ve received bad news in the mail – a letter from your company’s workers compensation insurance company. They’ve denied your claim and will not pay benefits.
What Do I Do if My Workers Compensation Claim is Denied? 
The scenario I’ve given is common. Even if you do everything right after a work accident, the insurance company may still deny your claim. But you don’t have to accept that answer. Here is what you should do next:
1. Read the Insurance Company’s Denial Letter
Most denial letters do not go into great detail about why your claim is denied. Usually they contain a vague sentence that says something like, “You did not sustain an injury by accident arising out of and in the course of your employment,” or “Your injury is not covered under the law.”  These are conclusions that do not tell us why the claim was actually denied.
Sometimes however the denial letter will provide more information. It may state that your claim was denied for one of the following reasons:
  • You did not report the injury to your employer in time. If you wait more than thirty days to report your accident and injuries, you may be barred from receiving benefits. Further, the longer you wait to report the accident the more likely it is that the insurance company will want to investigate.
  • You did not file a claim in time. If you wait more than two years to file a claim for benefits with the insurance company or the local Workers’ Compensation Commission, you may be barred from receiving benefits under the statute of limitations.
  • No medical treatment. You will have a difficult time winning your case without medical treatment.
  • Insufficient evidence that your injury arose out of a risk of the employment. Getting hurt at work is not enough to receive benefits. You must prove that a specific risk of your employment contributed to your injury.
These are just some of the reasons your claim may have been denied.
2. Contact an Attorney
Sometimes the insurance company gets it right and the claim should be denied. But more often than not I think they have made the wrong decision and are looking out for their bottom line and not the injured employee.
I recommend contacting a workers compensation lawyer Fredericksburg VA relies on for a free consultation. The lawyer will interview you and listen to your story, and may ask you to provide medical reports. Then he or she will tell you if they think the denial was appropriate, or if you should appeal.
3. Appeal the Denial
In states like Virginia, you appeal the denial by filing a claim with the Workers’ Compensation Commission. I recommend hiring an attorney to file the claim, since there are specific things you need included.
After you file a claim, the litigation process begins. Both parties may issue discovery to the other side, which includes things such as interrogatories and requests for production. And the parties may depose key witnesses. Many injured workers have to testify at a deposition.
If the parties are unable to reach an agreement, you will need to attend a hearing before a deputy commissioner. This judge will listen to and review evidence, then issue a written decision. Both parties can appeal this decision.
Workers’ compensation is complicated. Don’t give up if the insurance company denies your case. Contact an attorney to determine if you should keep fighting.
CoreyRPollardThanks to our friend and contributor, Corey R. Pollard, Esq. of Jenkins, Block & Associates, P.C. for his insight into denied workers compensation claims.