The process for filing a workers’ compensation claim can be complicated, especially if the claim is later denied. Employers and insurance companies want to avoid increasing expenses and liability, and will deny paying workers’ compensation if possible. Employees need to avoid common mistakes to ensure their claim moves ahead unabated.
Employees will receive a letter stating whether a claim is approved or denied, and that will list the reason for denial. Common reasons that workers’ compensation claims are denied include:
- Claim was not reported or filed on time
- Employer disputes the claim, often due to lack of evidence
- There is a discrepancy between the accident report and medical records
- Certain conditions may be precluded, such as stress-related conditions, depending on the state
- Injuries are not severe enough to qualify for a claim
- The employee filed the claim after being fired or laid off
The letter may also describe how to appeal a denied workers’ compensation claim. It is important to pay close attention to how the appeal process works and note any deadlines.
Before filing an appeal, check that everything was filed properly and the employer or insurance company did not make any clerical errors. You may be able to fix the denial without going through the appeals process.
The appeal is handled at an administrative hearing with an administrative law judge. You will be required to prove that your injury was work-related or an occupational disease. Medical records and other factual documents will help prove your claim. The decision can continue to be appealed through the court system.
Employees may lose their benefits simply because workers’ compensation appeals are a complicated legal process. For sound guidance on your workers’ compensation claim denial, contact the North Carolina attorneys at Lanier Law Group, P.A.