Filing for workers’ compensation, in and of itself, can be a stressful experience. Learning that your claim has been denied can magnify this stress. It is surprising and disappointing to receive a letter from an employer’s workers’ compensation insurance or claims administrator that says that a claim is delayed or denied. Unfortunately, it is not uncommon for insurance carriers or claims administrators to find a basis for denying that your injury occurred at the workplace, or that you were acting as an employee at the time of the injury. The first thing to understand is that should such a hiccup in the process occur, it is not automatically the end of the workers’ compensation claim process.
Should an injured employee’s claim be denied, it is important that he or she understand possible reasons why the claim may have been denied, and what steps should be taken next.
There are many reasons for delaying the determination. A delay letter will explain the reason(s) as to why a claim was delayed, and what additional information is required for the adjuster to determine whether a claim will be admitted or denied. Keep in mind, an adjusting agency is required to respond to a claim in a timely manner. Therefore it can be easier for them to send a delay letter rather than conduct an investigation.
The first step to take after a workers’ compensation claim has been denied is to read the denial letter carefully. The letter may also describe how to appeal the denial of the claim, and provide important deadlines that must be followed.
The workers’ compensation appeal process can be difficult without the help of an attorney. The lawyers of Agee Clymer Laret and Mitchell are available for a free consultation for any injured worker wanting to appeal a denied claim for workers’ compensation.