When you are working on the job, you have various protections that you are obligated to receive from your employer. One protection you are offered, and the one that we are going to be covering today, is workers’ compensation. Workers’ compensation is a form of compensation given to employees in the event that they are injured on the job, particularly if they are forced to miss out on work as a result.
For instance, imagine if you are working at a restaurant, and you receive severe enough burns that you can no longer work, your employer may be required to pay workers’ compensation due to improper safety measures or unsafe work conditions. It is not just injuries, however; in the event that you get sick from your job, you can also be approved for workers’ compensation.
Can your workers’ compensation application be denied?
Not all accidents or harm are necessarily going to result in workers’ compensation, alas. Sometimes, this is justified. For instance, if the worker’s harm was due to their own negligence, they may be denied. Another reason, a more procedural one, is if you fail to do the proper measures; ie, reporting the injury in the allotted time period, or if you fail to go to the doctor.
These are necessary for employers, with the doctor visit done in order to ensure that your injury and/or illness was valid. They may also find that the injury was due to outside elements that the business did not have anything to do with. But other times, your employer may deny it unjustly, simply to avoid having to pay out.
For instance, independent contractors and other workers not covered under their employer’s insurance may find themselves up a creek without a paddle when it comes to receive workers’ compensation from their employer. In any of these cases, the important question to ask is this: how do you respond to having your workers’ compensation denied?
The first steps to take in response to a denial of a workers’ compensation claim
It may feel rather demoralizing when you have your workers’ compensation application denied. Despite that feeling, it is not the end, as you can still file an appeal against their decision. The process is not a simple one, so you may benefit from consulting with attorneys who specialize in dealing with workers’ compensation cases. This can provide a much-needed ally in your corner to understand the nuances of this complicated process. They can walk you through it, as well as help strengthen your case to reduce the chances of your appeal being denied. A lawyer can also help independent contractors figure out how to get payments for their injuries and/or illnesses.
How to prepare for the appeals process
The first thing to do when you begin to file your appeal is to find out exactly why your employee denied your claim in the first place; after all, not doing so makes it that much more difficult to properly respond in your appeal and address their concerns and objections.
You may also benefit from trying to see if the insurer will reconsider their decision; while this is not necessarily effective, it may prove beneficial for both of you if you are able to convince them to overturn their decision in the first place.
You have to make sure that you are timely in filing your appeal, however, as virtually any employer will have a timetable that you have to adhere to.
Your lawyer may also recommend that your injuries and/or illnesses be assessed by an independent medical examiner, as there is a distinct possibility that the diagnoses that your medical examiner comes out with turns out to be different than the one your employer came up with. By having this, it provides a solid ‘in’ for your case and a possibility for your appeal to be passed.
Is the appeals process the same from state to state?
While there is general advice that you can and should follow through the process as written above, unfortunately, there are nuances to be found, as each state has its own laws regarding workers’ compensation, which is where a lawyer specializing in workers’ compensation cases comes in.
One with such a specialty, specifically in the state’s laws, can educate you on your state’s laws specifics. Some states will have your appeal reviewed by a review board, while others will have the appeal reviewed by an administrative law judge instead.
A follow-up appeal can also be done if your initial appeal is denied, although the method of appealing will be different from state to state. Although at this point, no new evidence beyond the previous appeal ruling can be considered. As such, you want to make sure that your initial appeal is strong enough to make it through the process of having your claim denied for workers’ comp.