How to Handle a Workers’ Compensation Claim That Has Been Denied

What options are available if your employer denies your workers’ compensation claim?

There are some denials that are valid, such as when a claim is filed fraudulently; however, many workers’ comp claims are legitimate. If your workers’ compensation claim has been denied, you are allowed by law to fight for your benefits through an appeals process. A Missouri workers’ compensation attorney from The Law Office of James M. Hoffmann can help you file an appeal and fight for your rights. Take action now to protect your rights to compensation for lost wages and medical bills.

Why a Workers’ Compensation Claim May Be Denied

The insurance companies that provide the workers’ compensation benefits have a standard protocol that they follow in an attempt to pay out as little as possible, even for valid claims. They may contest that the injury is not work-related. This is done in a number of ways:

• The insurance company may determine that the injury or condition was an aggravation of a pre-existing condition. In some cases, workers’ compensation benefits may be denied if the injury or condition was present before employment or the accident. Discuss the details with a work injury lawyer before giving up your right to benefits.
• The insurance company claims that the injury is not work-related. For example, if they found that you were in a car accident recently, they may say that the injury stems from the car accident and is not work-related.
• The employer may declare a worker to be an independent contractor rather than an employee. Since independent contractors have no expectation of benefits, this protects them from high premiums.
• An insurance company will also look at the procedures for filing a workers’ compensation claim and look for places where you may have deviated from them. For example, you must report an injury as soon as possible in order to receive benefits. If you delay informing your employer of a work-related injury, the insurance company will try and use that to reject the claim.
• The insurance adjustor may claim that an injured worker was drunk or under the influence of illicit drugs at the time of the accident. This is one of the rare instances where blame for an injury at work could be applied and you could be denied your benefits. In this case your best option is a Missouri workers’ compensation attorney who will discuss with your legal options.

Workers Compensation Claim

Influencing Factors & Denied Claims