If your workers’ compensation benefits have been denied in whole or even in part, it is not the end of the road. But you need to get legal guidance as soon as possible. The longer you wait, the more difficult your case will be to win.
Remember: simply filing for workers’ compensation does not automatically lead to the benefits you need. You have to present medical evidence and proof that your injury is work-related. The best way to do that is to put an experienced workers’ compensation lawyer on your side as soon as possible.
Don’t wait around on the insurance company or your employer. You have to be proactive.
The biggest thing is this: If you are unable to work because of a work injury and your benefits are not being started timely, and your feeling is that the workers’ comp insurance company or your employer is just going to be “difficult” in how they handle the claim, contact an attorney right away.
DO NOT just sit at home waiting for something to happen. Why? Because if the insurance company or your employer does not send you for medical treatment immediately after you report being injured on the job, or if your weekly benefit checks do not start immediately after you are taken out of work, it’s not all of a sudden going to happen some time later, after the insurance company has “investigated” your claim. By that point, your bills are piling up, you are hurt, and no money is coming in. Always be proactive and at least contact an attorney to find out what should be happening with your case at that point in time.
A note about reporting your injury
At the Law Office of Perry Dean Ellis, we represent a lot of people who are hurting from doing their job. Not a specific incident has happened, but they are hurt from repetitive lifting, bending, climbing, squatting, etc. If you feel that your job duties may be the cause of your pain, even if you are not 100% sure, tell your employer that you think the cause of your pain is from your job duties, even if there was no specific incident. Your employer may deny your claim, but at least you are letting your employer know that the physical repetitive job duties are likely the cause of your condition or injury.
Also, tell your doctor or the hospital emergency department the same thing. If you have severe back pain, and you think it’s from heavy repetitive work (even if no specific incident happened) let the medical provider know that you have a very physical job and the continuous heavy lifting, bending, squatting or climbing is the cause of your pain. Getting that causation documented in your initial ER records can be crucial to a successful workers’ compensation case!
What are the next steps?
Typically, if your benefits have been denied, the next step involves appealing the decision and submitting more information about your case. You might need to submit medical records or undergo another examination to prove that your injury prevents you from going back to work right away, or that your injury prevents you from performing all the work-related duties you did prior to the injury.
You may also need to present further evidence of your pay to determine how much you should receive in weekly benefits.
Depending on the facts of your case, it may be necessary to request a hearing before a workers’ compensation judge. As with every aspect of your workers’ compensation claim, it is best to have a workers’ compensation attorney represent you at the hearing before a judge.
Common reasons for denied benefits
Insurance companies and employers will look for any reason they can find to deny workers’ compensation benefits. Common reasons for denied benefits include:
- Insufficient medical evidence
- Filing errors
- Gaps in medical care
- Waiting a long time to report the injury
- The employer’s claim that the injury wasn’t work-related
- The employer’s claim that the injury was due to drug or alcohol intoxication — IMPORTANT: Even if a drug test revealed traces of a substance in your system, you may still be eligible for workers’ comp benefits. Likewise, you may be eligible for benefits if your employer has already fired you.
Ideally, collecting workers’ compensation benefits would be an easy process that allows you to support yourself and your family while you heal from your injury. Unfortunately, insurance companies routinely make it difficult for injured workers to apply for and receive benefits.
If your claim is denied in whole or in part, don’t hesitate to contact an attorney to help you navigate the appeals process and get your claim approved as quickly as possible.