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What to Do If Your Workers Compensation Claim Is Denied

On Behalf of | May 16, 2014 | Workers' Compensation |

Receiving notice that your workers compensation claim has been denied will bring forth many reactions, mainly fear. How will you provide for your household if an injury renders you unable to work? How will you pay the medical bills? Receiving a Notice of Denial is not the end of your workers compensation claim. There are other avenues still available, especially if the claim is denied for merely clerical or administrative reasons. However, if your claim was denied due to a lack of proof regarding medical conditions and workplace occurrences, you will need to understand the appeal process and consider hiring legal counsel.

Review the Notice of Denial

Workers compensation claims must be accepted or denied within 45 days of the initial application. If denied, you will receive a Notice of Denial. The notice will explain the reasons for claim denial. Some problems may be fairly minor, such as forgetting to file or sign a form, and correcting that error can place your claim back into consideration. Others reasons such as lack of medical evidence, missed deadlines, or no documentation of a workplace accident will require additional steps. Note any deadlines in the Notice of Denial. Letting them pass without attention will forfeit any rights to workers compensation benefits.

Collect Records

If the issue with the claim is a lack of evidence or the insurance company has concluded that your injury was not workplace related, further steps will be necessary. You will need to file an appeal and the claim will be assigned to an Administrative Law Judge (ALJ). The ALJ will start with an informal Benefit Review Conference where issues of the claim are discussed between you and your employer’s insurer. If the claim remains unresolved, a hearing will be scheduled in front of the assigned ALJ. Both the conference and hearing requires you to submit evidence. This includes medical records, accident reports, or eyewitness testimony. If in doubt, you should request a copy of the insurance company’s file so you can see the reports they based their decision off of. These documents are very important. The most common reason for claim denials is insufficient medical documentation. You may also have to prove your injury is due to the workplace and not a pre-existing condition. Insurance companies may allege you failed to seek medical treatment. The documents listed above can help show the Notice of Denial was incorrect. If the ALJ denies the claim, the claim can be appealed to the Workers Compensation Board. That appeal must be filed within 30 days after the final decision of the ALJ. Further appeals are taken to the Kentucky appellate courts.

Talk to an Attorney

While it is possible to represent yourself in your claim, workers compensation law is heavily procedural and very complex. Workers who represent themselves are held to the same standard as skilled attorneys. Completing forms incorrectly or missing deadlines will not be forgiven just because a claimant does not have legal training. Since Workers compensation attorneys work on a contingency fee basis so there are no upfront costs to you. Contact Edwards and Kautz for a free consultation. If we can help you with your Kentucky Workers Compensation claim, fill out our contact form or call 270-908-4914 so we can get started in securing a fair settlement for your workplace injuries.