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What Should I Do if My Workers’ Comp Claim Is Denied?
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What Should I Do if My Workers’ Comp Claim Is Denied?

What is Workers’ Compensation Insurance?

Workers’ Comp Claim – Your employer pays monthly premiums for this insurance for all employees because it is the law across the United States, except for the state of Texas. If you are hurt or injured at your job and cannot work for the short or long term, you can file a compensation claim or lawsuit to help pay your wages and mounting medical bills associated with your accident/injury.

Be aware that many employers do not want to pay you any more compensation than they must, and millions of claims are denied daily for various reasons, and unfortunately, money is the bottom line in any compensation claim.

A Seasoned Accident/Injury Attorney Fights for Your Compensation Rights of Workers’ Comp Claim

If you receive injuries on the job, please immediately call a seasoned and experienced wrongful accident/injury/death attorney to make sure your compensation claim pays you what you are entitled to receive and you are not denied your compensation claim. If you do not hire a compensation attorney, your employer, insurance company, and the attorney can take advantage of your situation.

Never feel embarrassed or guilty about calling a wrongful injury attorney. You are protecting your rights as a victim. You can bet that your company has a team of seasoned attorneys working for them. You will never win your claim by representing yourself.

Generally, when you file a compensation claim and cannot work due to your injuries, there is a seven-day waiting period before you can start to receive money that pays for your wages. This compensation is not your total wages but is a percentage of your weekly net income. Compensation should also start paying all your medical bills associated with your injury, but often the insurance company is slow in paying these bills and often refuses to pay.

You have 24 hours to turn in an accident/incident form to your employer detailing what happened to you. Would you please make copies of all the paperwork you turn in to your employer and insurance company and keep it in a safe place? Never assume that your boss is your friend and would do anything for you.

Over half of these claims end up paying the injured employee within a year of filing. Filing a workers’ comp is always an uphill battle, which is why you need your accident/injury attorney by your side.

Workers’ Comp Claim – Denial of Compensation Claims

If the compensation insurance sends you a denial letter it explains your right to file an appeal and how to file this appeal. It tells you that you have 30 to 90 days to file your appeal and you dare not miss this deadline. It is your attorney who can keep your claim from being denied in the first place. Some states have different levels of the appeal process. Denial of compensation could be due to,

  • Possible fraud
  • Administrative or clerical error
  • An irregularity in the system, such as a technical error
  • Employer attorney proved that you did not deserve compensation.

You and your workers’ comp lawyer must review all of your documentation. Remember, you keep copies of everything and have them neatly filed in a folder for quick access.

The next step is to file an appeal. At this point, things become convoluted and complicated, but you have your attorney by your side protecting your rights. Your insurance is not working for you; it works for your employer. In many instances, things start to turn in your favor when your employer and their insurance company find out you have a seasoned and experienced attorney working for you.

  • You may have to have a second opinion or physical exam by another doctor regarding your accident and the injuries associated with this accident.
  • Your employer’s attorneys may set up a mediation conference with a third-party neutral person to propose a settlement of sorts. However, this person cannot force a decision from either party.
  • At this informal meeting, a discussion and debate proceed regarding your payment. This meeting is not a court, so there are no witness statements or oaths taken. A mediator or third party is assigned to your case to assist both sides in agreeing to your settlement.

If neither side can agree on a settlement and the meeting fails, the next step is an administrative hearing with an administrative judge, and the burden of proof is on you. It would be best if you had your attorney by your side, and we would be there fighting for and guiding you through this process. The judge can take several days or weeks to decide on your appeal. This meeting means that,

  • We present evidence through witnesses and cite pertinent employment laws of the state.
  • We will highlight your medical records.

Further appeals may be possible. A panel of workers’ comp judges and a workers’ compensation appeals board are in charge of this second appeal. This meeting is the time to argue about any errors by the hearing officer. This second appeal process could take months to complete.

If the second meeting fails, you have the right to take a final step towards compensation through your state’s court system. However, a settlement may arise. This last process can take years to complete. Your employer and the insurance company may argue that,

  • Your incident report and claim are inaccurate.
  • You were not at work when you were injured.
  • Your verbal and written description of your accident does not match.
  • You were not doing your job when you were injured.
  • Your accident injuries were not covered under your state’s workers’ compensation laws.
  • Your injury is not covered.
  • You were injured, but you never received medical care; thus, you do not qualify for benefits.
  • A doctor other than your employer’s compensation doctor treated your injuries.
  • A pre-existing condition can deny your compensation claim unless you prove that your accident/injury worsened your condition.
  • Employer attorneys fight to deny a claim if you aggravated an old injury.
  • You lost your job to termination, were laid off, or quit before you filed your claim.
  • You refused to give a recorded statement regarding your accident/injury.
  • There were no witnesses to your accident and injury. (It makes a big difference when you immediately report your injuries to co-workers and employers. Take pictures of your accident site as soon as you are injured.)
  • You were under the influence of drugs or alcohol at the time of your accident and injury.
  • You were negligent in causing your accident and injury unless someone else was negligent and caused your injuries.

For the above reasons, you need your attorney immediately following any workplace accident/injury case. We know all the Texas state laws related to workers’ compensation. Give us a call as soon as possible after your accident and injury so we can get to work for you and protect your employee rights.

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