An injured employee is eligible for Workers’ Compensation benefits. Sometimes, an injured worker is denied their claim to these benefits. When this happens, it can be advantageous to seek out legal counsel for advice on the next steps to take. A knowledgeable lawyer can work within the system to prove that their client’s denied claim should be re-examined and ultimately approved.
What Conditions Must be Met to Qualify for Benefits?
In order to be compensated for a workplace injury or occupational illness, the accident or incident must have taken place in the course of employment and related to work tasks. The injury must be the result of the employee performing job duties within the course and scope of their employment.
After a work accident happens, it is important that the employee reports the injury, receives medical care, and speaks with a lawyer. Performing these steps will reduce the likelihood of a denied claim.
Why are Some Workers’ Compensation Claims Denied?
While each case is different, there are some reasons that commonly lead to denied Workers’ Compensation claims. Some common examples include the following:
- A rejection that the incident happened as a result of employment duties.
- The type of injury suffered is not covered under the Workers’ Compensation policy.
- Reporting the injury to the employer failed to happen within the timeframe allotted by state law.
- The filing for benefits did not take place before the designated deadline.
- Suspicious timing of the claim.
- A lack of witnesses to the incident, which may cause doubt.
- Specific inconsistencies in the report that may raise misgivings about the case.
- The presence of a pre-existing condition that may raise questions about the origin of the injury.
- A lack of cooperation in providing information to support the claim.
- A drug test that reveals that intoxication was at play at the time of the accident.
- An understanding that the injury resulted from a physical altercation initiated by the claimant.
- An indication that the injury was intentional.
The reason for the denial of the Workers’ Compensation claim should be detailed in the notice given to the employee. With this information, the employee may begin to mount a case to appeal the decision reached by the insurer. A skilled lawyer will be able to help with the appeal.
When is it Necessary to File an Appeal?
Before taking steps to file an appeal, the employee should discuss matters with their employer or the employer’s insurance company to attempt to provide necessary evidence to support their claim for benefits. This step may be unfruitful, but it is worth taking. If this fails to change the decision to reverse the denied benefits, the employee may appeal with the help of a lawyer.
What is the Procedure for Appealing a Denied Claim?
If a claim for a workplace injury is denied by an employer’s insurance carrier, the employee may appeal that decision to a judge or state board who is tasked with overseeing the Workers’ Compensation case. This process has rules and deadlines that must be observed. These rules and deadlines should also be found in the denial letter. While the appeals process varies among states, it usually involves presenting evidence before a judge or panel.
What Types of Evidence can be Used to Support an Appeal?
Depending on the reason stated for the denial, the employee can present evidence to support the case that they should qualify for Workers’ Compensation benefits. If the reason provided in the denial letter is that the injury is ineligible for coverage because it is not work related, the employee may argue against this assessment. An employee and their lawyer can provide timesheets and emergency room records to show time stamped evidence of when the injury happened.
Similarly, if the denial was issued based on an inaccurate sense of the reporting timeline, the employee may reveal emails that are dated to show when the injury was reported to the employer.
How can a Lawyer Help?
While it may be possible for an injured employee to file and execute a Workers’ Compensation appeal on their own, it can be invaluable to have a lawyer. A lawyer will provide advice and assist during the entire process. Appealing a Workers’ Compensation denial can be difficult to navigate for someone unaccustomed to the process. A lawyer with experience can determine if the case has merit. If there is valid justification for an appeal, a knowledgeable lawyer can prepare a strong case to support the claim for the fair distribution of benefits.
If a person is injured at work, they should be able to collect benefits to cover expenses related to the accident. A hurt worker is entitled to benefits to cover medical bills, including emergency room visits, follow-up doctor visits, as well as medications. If a worker is denied benefits, they should speak to a lawyer right away.
Vineland Workers’ Compensation Lawyers at DiTomaso Law Help Injured Employees Appeal Denied Claims
If you were hurt at work and your claim was denied, you should speak to one of our trusted Vineland Workers’ Compensation lawyers at DiTomaso Law. Our experienced legal team can help you appeal your claim and prove your case for fair compensation. Contact us online or call us at 856-414-0010 for a free consultation today. Located in Cherry Hill, New Jersey, we serve clients throughout South Jersey, including Mt. Holly, Camden County, and Vineland.