Denied Workers’ Compensation Claims

Columbus Ohio Denied Workers’ Compensation Claims

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.

Possible Reasons for Delay or Denial of Workers’ Compensation Claims

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.

Workers’ compensation claims can be denied for many reasons.  One common reason for denial is that the claim was not reported or filed within a proper timeframe.  Employees are required to report a claim immediately, sometimes within only a few days of the workplace injury.  The employer must then inform their workers’ compensation insurance carrier, or the state, just as quickly.

Another common reason for denial of a workers’ compensation claim is the employer disputing the claim.  This can occur because the employer says that the injury is not covered; disputes the location of the injury (for example, they may claim that it happened while the employee was at home); or disputes that the injury is a result of the accident.  If an employer disputes the claim, the employee will need to gather additional evidence to support the claim, such as witness statements, incident reports, or statements for a doctor attributing the injury to an occurrence at work.

What to Do When a Claim Has Been Denied

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.

After carefully reading the denial letter, an employee should consider contacting the employer or its workers’ compensation insurance carrier to discuss the denial.  If the denial was due to a missing document, misspelled name, or similar issue, the mistake could be cleared up easily.  However if the employer still refuses to allow the claim, it may be time to appeal the denial.

Should an appeal be necessary, it is important to contact a workers’ compensation attorney to understand your rights and duties during the appeal process.

Schedule a Free Consultation with Columbus Workers’ Compensation Lawyers

The workers’ compensation appeal process can be difficult without the help of an attorney.  The lawyers of Agee Clymer Portman and Mitchell are available for a free consultation for any injured worker wanting to appeal a denied claim for workers’ compensation.

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Worker’s Comp Lawyers Columbus, Ohio - Agee Clymer

140 E. Town St. #1100
Columbus, OH 43215