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A denied workers’ comp claim: What’s next?

On Behalf of | Aug 7, 2020 | Uncategorized |

A work injury can be expensive. If you were hurt at work, you may need medical care and time away from work to recover. Doctors and necessary treatment can be costly, and if you are unable to work, you are not bringing in your normal paycheck. This can be financially devastating for a North Carolina family, especially when there are other bills to pay.

If you suffered an injury in a work accident, you may have grounds to file a workers’ compensation claim. Workers’ compensation comes through your employer’s insurance policy, and it can provide you with financial support during your time of recovery. Even with a valid claim and work-related injury, your claim could come back denied. At this point, an appeals process can allow you to continue your pursuit of benefits.

Reasons for denial

Before you file for workers’ compensation benefits, you should remember that these insurance companies do not have your best interests as their primary goal. They are most concerned with their own bottom line, and this is why they carefully scrutinize any benefit claims. Some of the most common reasons they give for a denied claim include:

  • The applicant did not file the claim within the required window of time.
  • The employer is disputing the claim for benefits.
  • The injured party did not include enough documentation in the claim.
  • There is insufficient evidence that the injury is work related.
  • The worker did not report the injury in enough time.
  • The injury is not compensable or did not require medical treatment.

Once you know why your claim came back denied, you can move forward with the appropriate steps to appeal. The insurance company includes their explanation for the denial in the letter sent to the applicant. You can gather additional documentation and take steps to correct any errors or include more information necessary to validate your claim for benefits.

Getting better and returning to work

Workers’ compensation benefits not only cover your medical bills and a portion of your lost wages, but there are also types of support available to you that can help you get back to work when it is time. A denied claim is much more than an inconvenience. It can affect you and your family long-term.

From the moment you realize you will need to file a workers’ compensation claim, you will find it beneficial to work with an attorney experienced in this insurance claims process. This can help you avoid setbacks and give you a greater chance of success with your claim or appeal.