What Happens When Workers' Compensation Is Denied?

The hours after a workplace accident are stressful and disorienting. No matter what type of injury you sustained, it can be difficult to know how to proceed.

You must take certain steps to file a successful workers’ compensation benefits claim. If you have questions about this process, a skilled legal professional at Morgan and Morgan can help.

Report the Injury

For the sake of your earned benefits claim, you should report your workplace injury or illness to your employer as soon as possible. Most states set a timeline by which you must inform your company about the incident if you hope to recover benefits. 

Seek Medical Care

Regardless of the type of injury you have sustained, it is critical to seek medical care. In some instances, you may be required to visit a physician chosen by your employer or their insurance company. 

Securing a medical assessment will ensure you receive a proper diagnosis and begin any needed treatment. Do not hesitate or put off visiting a medical care provider in the aftermath of a workplace injury. 

Also, make sure that the doctor records the cause and context of your injury. In other words, your medical records should affirm that your condition is work-related.

File Application Forms

When you report your medical condition to your employer, they should provide you with the requisite documents to file for workers’ compensation. You should fill these forms out as quickly and accurately as possible. 

These documents should be filed with the employers’ insurer and also with the state workers’ compensation agency. Once you submit the required documents for your earned benefits application, you should receive a decision regarding your case.  

If your claim is denied, make sure to consult with an attorney about options for appealing the decision. The lawyers at Morgan and Morgan know what is necessary to fight for the rights of injured workers.

Most states require businesses to carry workers’ compensation insurance policies. This is to ensure that victims of workplace injuries can get back on their feet. 

When a claim is wrongfully denied, the injured person can appeal through their state’s workers’ compensation board. However, this process is complex and involves many requirements. 

So what happens when workers' compensation is denied? The first step you should take is determining the reason for the denial. 

The rationale for not providing you with earned benefits should be described in the rejection letter. There are many reasons that workers’ compensation applications are denied.  

Some of the most common reasons for an earned benefits application denial include:

Failure to Report an Injury on Time

One common reason for a denial is that the application was not filed on time. Each state has laws that determine when you must report a workplace injury if you hope to secure benefits. 

In most cases, injured workers must report their medical condition within a few days of the initial incident. If you wait to report your condition, the insurance provider may reject your claim.

Failure to File a Claim on Time

Injured employees are also required to file the workers’ comp application paperwork within a given time frame. Failing to file your application within the state’s time limit can result in a denial. 

Many states require applicants to file within 30 days. Others allow up to 90 days for victims to file a claim.

Employer Dispute

If your employer disputes the validity of your workers’ compensation claim, it may result in a denied application. For instance, your company or supervisor may claim that the incident did not happen at work. 

They may also claim that the injury resulted from your own carelessness or “horseplay.” There are many reasons that your employer may cite to dispute the legitimacy of your claim.

Non-Compensable Injury

The nature of some injuries makes it very difficult to prove they are work-related. For example, it can be challenging to show that a repetitive motion injury was the direct result of your employment. 

Suppose that you develop a hand or wrist injury as the result of typing at work. It may be difficult to show that the long-term engagement in your job function is the cause of your condition. 

A skilled lawyer will gather relevant evidence to bolster your workers’ compensation claim and prove that your work caused your injury or illness. This process may involve gathering additional evidence or scheduling more medical assessments. 

Lack of Medical Treatment

If you do not seek medical care in the aftermath of your illness or injury, your claim may be denied. The insurance provider may cite the lack of a medical examination as evidence that your injury is not severe enough to warrant compensation. 

Do not let this happen to you. Make sure to schedule an appointment with a care provider as soon as you become aware of your illness or injury.

After determining the reason for your denied claim, you can file an appeal to overturn the decision. In some cases, an appeal is unnecessary. 

Before pursuing an appeal, you can speak with your employer to attempt a resolution to the dispute. However, it is best to hire a workers’ compensation attorney when you have been denied benefits.  

The workers’ compensation appeals process varies in different states. Typically, the claimant must attend a hearing in front of an administrative law judge. 

This process may involve the state workers’ compensation board or the labor department. In some cases, appeals may go through many different stages. 

That is why it is critical to speak with a lawyer from America’s largest tort firm—Morgan and Morgan. Our skilled legal professionals know how to navigate the workers’ compensation process in every state.

No matter why your application for workers’ compensation benefits was denied, we can help. Having a knowledgeable legal representative working on your behalf will give you the highest likelihood of a successful appeal. 

When you attend your hearing, make sure to bring all of the documentation related to your case. This can include: 

• Medical records and doctor’s notes
• Photographic evidence of the worksite
• Testimony from witnesses to the accident
• Statements from medical experts or specialists
• Medical bills and invoices
• Timesheets providing records of your working hours 

Your attorney will use the relevant evidence to argue effectively on your behalf. Following the appeal hearing, you will receive an updated decision on your case. 

If your claim is still denied or devalued, your attorney will help you explore further legal options. You should never settle for less than the full value of your workplace injury. 

Fortunately, the accomplished legal team at Morgan & Morgan is here to help. Our firm has been successfully representing injury victims across the United States for three decades. 

Do not settle for less than the best legal advocates. Reach out to the compassionate workers’ compensation lawyers at Morgan & Morgan to discuss your claim.

In the aftermath of an on-the-job injury, victims typically sustain a wide range of monetary challenges. Being injured in the United States is a very expensive prospect.

Unlike financial damages in other types of personal injury claims, workers’ compensation benefits do not cover all losses. Payments for workers’ compensation only cover the employee’s direct monetary losses resulting from their medical condition. 

For example, workers’ comp payments are meant to cover: 

• A portion of lost wages and income
• Medical visits and expenses
• Necessary medication and surgeries
• Partial disability
• Total disability
• Required ongoing medical care 

However, these earned benefits do not cover any emotional or personal damages resulting from an injury or illness. In personal injury claims, these compensatory payments are called “non-economic” damages.  

Non-economic damages include physical pain, mental distress, and decreases in quality of life. While workers’ compensation benefits do not cover these losses, you may be able to file a third-party lawsuit if another person is partially responsible for your injury.

When victims are dealing with the financial demands of an illness or injury, it is understandable that they would be concerned about the cost of legal representation. Fortunately, the legal professionals at Morgan & Morgan are compensated through contingency fees. 

When you hire a Morgan & Morgan lawyer, we will agree to represent you for a specific percentage of the recovery in your case. You will not pay a single dime in attorneys’ fees unless we recover the money that you rightfully deserve.

If you have been hurt while working, you may be able to recover compensation for the losses you experience. With the help of a lawyer focusing on workers’ compensation, you can fight diligently for the money you deserve. 

If your workers’ comp claim has been denied, schedule a free consultation with our compassionate legal team. We will happily review the facts of your case and help you choose the best course of action.  

Arrange your no-cost initial meeting by completing the case evaluation form online. Let the attorneys at Morgan & Morgan fight for you.