Understand The Process To Appeal For A Denied Workers’ Claim
Being a worker and laboring alone is tough, what more if you get injured at the workplace? Workers’ compensation is a legal term for the damages awarded to an employee injured on the job to help them pay for expenses and lost wages. Filing a claim is one of the processes to get compensated, but sometimes it gets denied. Find out how to appeal a denied workers’ compensation claim with a workmans comp lawyer in Saint Peters, MO.
Quick Summary:
- Workers’ comp, short for workers’ compensation, is a system that provides financial benefits and medical care to employees who are injured or become ill because of their job. It’s a form of insurance employers must carry by law to protect employees and limit lawsuits.
- Missouri has specific laws to follow regarding workers’ comp claims denial. In this state, you must file complaints within 20 days, and 30 days if this claim is still unheard of. It is also important to gather evidence and contact a workmans comp lawyer in Saint Peters, MO.
- Workers’ comp claims can be denied for various reasons, including missing deadlines to report the injury or file a claim and disputes about whether the injury is work-related. If your claim is denied, you should review the denial letter and try to clarify any misunderstandings. If that doesn’t work, you can appeal the denial within the state’s deadline (usually 30-90 days). The appeals process varies by state but often involves a hearing before an administrative law judge.
What is Workers’ Compensation?
Workers’ compensation, often shortened to workers’ comp, is an insurance program designed to support employees who suffer work-related injuries or illnesses. This mandatory insurance, paid for by employers, offers financial compensation for lost wages and covers medical bills due to work-related conditions. In exchange for receiving benefits, employees generally give up their right to sue their employer for negligence.
What are the Reasons for Workers Comp Denial?
Being injured at work can be stressful, and the added burden of a denied workers’ comp claim can make a difficult situation even worse. Workers’ compclaims can be rejected for several reasons, some procedural and others based on the nature of your injury or illness.
No Witnesses to Your Injury
Insurance companies get suspicious if no one sees you get hurt. They might question what happened. Even if there were no witnesses, inform your boss and co-workers about the injury immediately. Ensure your story remains consistent whenever you discuss it.
Missed Deadlines
Each state has deadlines for filing a report. In Missouri, you have 30 days to report a workplace injury. Notify your employer first; then, the employer or insurer reports it to the Division of Workers’ Compensation within 30 days and carries it over to the insurer within five days.
Failure to Report Injury Immediately
Failing to report the injury immediately can cost you your claim, as companies can misinterpret or dismiss the seriousness of your injury. It is recommended that employees inform their employer and seek prompt medical treatment when they have injuries, as this could affect their claims.
Mismatched Information on Your Accident Report and Medical Records
Insurance companies might reject your claim if your explanation of the accident keeps changing. Telling your boss one thing, and the doctor another can make it seem suspicious. So, whenever you talk about the accident, keep your story consistent with everyone: your boss, coworkers, and doctor. That helps avoid confusion and strengthens your claim.
Substance Abuse
A track record of substance abuse issues could jeopardize your compensation chances. While workers’ comp extends its grace to various injuries, including negligence, it’s a whole other conversation when drugs are involved. Workers’ comp claims could be denied if you are intoxicated during the time of injury. That is also why companies require drug tests after a workplace injury.
Injuries Not Related to Work
If the injuries you’ve presented don’t seem work-related, that could lead to a denial on your workers’ comp. The common arguments against this include that the worker wasn’t on the job during the time of the injury/illness or that they were involved in an activity that caused the injury. That emphasizes the importance of gathering evidence during workers’ comp appeals. Evidence strengthens your case and enhances your chances of getting compensated.
Filing a Claim After You Were Laid Off
Let’s say you get hurt on the job, but you wait a while to file a claim for the injury. By the time you get around to it, you might not be working there anymore. Insurance companies get suspicious of claims filed after someone loses their job. They might think you’re just trying to get back at them. That’s why it’s crucial to file your claim quickly, even if you’re still working at the company. If you wait and lose your job later, it’ll be tougher to prove you got hurt at work.
What Do I Do If My Workers’ Comp Appeal is Denied?
Getting your workers’ comp claim denied can be frustrating, but it doesn’t mean you’re out of options. Here are the key steps to take:
- Understand The Reasons for Denial: First, get a copy of the denial letter. This document should explain why your appeal was rejected. Read it carefully to understand the reason for the denial.
- Review Your Options: Depending on the reason for the denial, you might be able to address the issue and resubmit your appeal. That could involve gathering more evidence, like medical records or witness statements.
- Consider an Attorney: Workers’ comp laws can be complex. Consulting with a workmans comp lawyer in Saint Peters, MO, can be beneficial. They can advise you on your legal options and represent you in further appeals.
- Appeal Timeline: Each state has deadlines for filing appeals. Don’t miss these deadlines! The denial letter should mention the deadline for your next move.
Don’t give up! Many workers’ comp claims are initially denied but eventually approved after an appeal. By following these steps, you increase your chances of getting the benefits you deserve.
How Do I Appeal for a Denied Workers’ Compensation Claim in Missouri?
Appealing for a work injury claim and getting rejected can feel like a crushing defeat. Given your injuries, it’s normal that you would want to fight back. Before appealing for denied workers comp, learn the ins and outs of Missouri workers’ comp appeals law first.
- File a Review Request: Filing a review request requires you to ask the Missouri Labor and Industrial Relations Commission to review your case. Note that the filing of this request must be done within 20 days of getting the denial letter.
- Appeal to A Court If Denied Again: If the Commission denies your claim, appeal directly to the Missouri Court of Appeals. Remember to appeal within 30 days.
- Gather Proof: Evidence is key when appealing for workers’ comp. That could be things like security camera footage showing you getting hurt, any reports you filed about the accident, or statements from people who saw what happened. The more evidence you have, the stronger your case will be.
- Discuss Before Heading to Court: Before you jump into a big fight, consider this: maybe it’s a simple mistake. The denial letter might be due to a paperwork mix-up or a misunderstanding. Try talking to your employer to see if you can clear things up. It could save you time and hassle.
Navigating the ins and outs of Missouri’s appeals process can be exhausting and taxing. That is why talking to a workmans comp lawyer in Saint Peters, MO, is a must as you undertake this legal battle for justice.
Get Your Workers’ Compensation Today!
Injuries are unfortunate and nobody wants to think they can happen during work. Accidents produce conditions such as hand injuries, broken bones, and lacerations, thus needing compensation. Sometimes, things go awry and you may find your workers’ comp appeal denied.
Find out the reasons why your compensation claim has been denied and fight right back with the help of our workmans comp lawyer in Saint Peters, MO, at Adams Law. Our lawyer is committed to helping clients throughout Missouri get compensated for back pain, respiratory disorders, electrocution accidents, and occupational hazards. Contact Adams Law right now for a free consultation.
