You have options if the insurance carrier denies your workers’ compensation claim. There are protocols in place to fight a denial and possibly secure the benefits you need and deserve. These steps vary by state and insurance provider, but a local attorney can help.
A workers’ compensation lawyer near you will know what you can do about a denied workers’ comp claim. They handle denials and other issues securing these benefits regularly. Most law firms offer free initial consultations for injured workers. During this conversation, you will learn your options and how they can help you. You can contact them quickly after you learn about the denial to ensure you meet all applicable deadlines. Reach out to a workers compensation lawyer.
What Should I Do if They Denied My Workers’ Compensation Claim?
If you received a denial notice related to your workers’ compensation claim, consider contacting an attorney’s office. Make the call immediately to get a lawyer working on your claim quickly. You do not need to panic. You have options for challenging this decision, and a local workers’ comp lawyer knows what they are and how to navigate them.
You can help move the process along by gathering all the documents and other evidence you have to support your claim. They could include information about your employment benefits, a copy of the written notification you sent your employer about your injury, any relevant medical records, and the denial notice you received. Your denial notice might also include information about your next steps.
You don’t have to fight a workers’ comp claim denial on your own. Having a lawyer familiar with these benefits in your state handle your case could make the process much easier and less stressful. Remember, you must act quickly. There are often short deadlines to challenge a denial, and it could take your attorney time to build a strong case for your benefits.
How Can an Attorney Help Me After a Workers’ Comp Denial?
When an injured worker hires a workers’ comp attorney, the law firm takes over the claim and manages all aspects of the appeal or other steps necessary to challenge a denial.
They understand the importance of these benefits and why you need them as soon as possible. Your medical care, financial well-being, and physical recovery are important to them, too. Your attorney can fight to get you the money and other benefits you deserve.
They Know the Claims Process
Workers’ compensation lawyers know how the process works. They handle claim denials and other issues with claims in your state daily. They understand how to navigate the appeals process or otherwise fight for the benefits you need and deserve. They can calculate your expected payout, review the policy, and handle the steps necessary to help you get coverage for your medical care and lost income benefits.
Workers’ comp lawyers know that their clients have a right to benefits after suffering injuries on the job. All covered employees should receive benefits if they suffer a qualifying injury or receive a work-related diagnosis.
When you call on a workers’ comp firm, your lawyer can handle your claim and any related problems while you focus on healing. This way, you only worry about your injuries, treatment, therapies, and rehabilitation. Your attorney can take care of the insurer and your benefits. Trust them with your claim and work to get better.
How Do I Appeal a Workers’ Comp Denial?
There is no one way to fight a workers’ comp benefits denial. Each state has its own rules for how workers’ compensation claims work, who handles them, and how to challenge denied claims. Sometimes, these rules even vary by insurance provider within the same state.
Before you take any action based on a benefits denial, you may want to discuss your case with a workers’ comp attorney to learn more about the rules in your state. Speaking with a lawyer or legal team member is easy. Most firms offer free case consultations for injured workers. Make the call and ask for a free initial case assessment. There is no charge and no obligation to hire the firm.
There are often only a few weeks to request a reconsideration or file an appeal, depending on the process necessary in your case. The denial notice usually includes this deadline. Because they are so short, you should act quickly after receiving the letter.
The following steps should include:
- Gather all paperwork and documents related to your claim.
- Call a local workers’ comp law firm to schedule a consultation.
- Discuss your options with the firm.
- Decide on your next steps.
- Move forward with your plan.
If you hire an attorney after your initial consultation, they can take over your case at this point. The attorney and their team can manage the appeal or other necessary actions, fighting for the full range of workers’ comp benefits you need and deserve based on the policy and case facts.
When Should I Consider Hiring a Workers’ Comp Lawyer to Handle My Denial?
Many injured workers don’t know when to call an attorney. Some believe they are making the call too early, while others could think they waited too long at the same point in the process. In reality, your lawyer can take over the handling of your claim when you hire them. It is probably not too early and rarely too late.
Some common times when injured workers enlist the help of a workers’ compensation lawyer include:
At the First Sign of an Issue
Consulting a lawyer at the first sign of a problem ensures you have someone on your side from the start. When injured or sick employees need workers’ comp benefits, they generally need them to begin as soon as possible. Any hiccup that delays them could cause financial stress and other significant worries.
Handing the case over to an attorney and asking them to fight for the benefits you deserve could help you get approval. Workers’ compensation lawyers know how insurance companies work and understand the rules for these benefits in your state. They often iron out issues before they cause major delays or lead to a denial, working to get you your benefits as quickly as possible.
When They Receive a Denial Notice
Contact a workers’ compensation attorney’s office immediately if you receive a denial notice. This is one of the most common times when clients hire a lawyer, and for good reason. Workers’ comp lawyers know how to handle appeals and other challenges to these decisions and could even take your case before a judge if necessary.
You only have a limited time to challenge a workers’ comp denial, so you must decide quickly. While some people try to handle the next steps independently, they often call an attorney later anyway. Your attorney is likely better equipped to challenge the insurer’s decision than you are on your own.
When They Don’t Know Their Options
Some people challenge a denial on their own and only enlist the help of a lawyer after their attempt fails. If this happens to you, don’t hesitate to hire a lawyer. If you have questions or concerns about your claim at any point in the process, reach out. There is no right or wrong time to get help from a workers’ compensation lawyer.
Who Is Eligible for Workers’ Comp and What Benefits Should I Receive?
Every state has its own workers’ compensation laws. These laws define which employers must provide benefits, which workers qualify, when the policy should pay, and the benefits an injured or sick worker receives.
In general, any covered worker who suffers an on-the-job injury, has a job-related condition, or develops a work-related illness could receive benefits. In many cases, they must receive their diagnosis and treatment from an approved doctor. This rule varies from state to state, too.
Who Qualifies for Workers’ Compensation Benefits?
States require some or all employers to provide workers’ compensation insurance for employees. It is usually mandatory for all companies over a certain size, such as those with four or more employees.
When an employer provides workers’ compensation insurance, the coverage must extend to all employees, such as full- and part-time, salaried, hourly, seasonal, and occasional employees. They should have coverage from their first day of employment.
What Benefits Are Available Through Workers’ Comp Insurance?
While the benefits available to injured workers vary somewhat based on the requirements in your state, some benefits you should expect if you get hurt or sick at work include:
- Medical care coverage: Workers’ compensation should cover all costs related to treating the workplace injury.
- Income loss benefits: This benefit provides a portion of the worker’s previous take-home pay, usually around two-thirds, up to a set limit.
- Death benefits: When a covered worker dies, a lump-sum death benefit is generally paid to their survivors. It provides some coverage for reasonable burial and funeral costs.
- Other benefits: You could qualify for additional benefits based on the policy. They often include training programs to help you learn a new trade or adapt tasks to new impairments.
The best resource for learning how workers’ compensation insurance works in your state may be to speak with an attorney who handles these cases regularly. If you do not have a work-related injury or claim already underway, your supervisor or human resources representative at work should have paperwork or can explain your coverage.
How Much Does It Cost to Hire a Workers’ Compensation Lawyer to Fight a Denial?
Workers’ compensation attorneys generally handle claims based on contingency fees. They do not ask clients to pay a retainer or other upfront fees. Instead, they use the firm’s resources to navigate the process and seek benefits or a payout for the client. The attorney’s fees come from the money recovered in the case. There is an agreed percentage of the total recovery paid to the lawyer at the case’s close.
Most law firms do not charge any attorney’s fees for workers’ comp cases unless they win your case and recover benefits or a payout. In other words, they do not get paid unless you do. However, their policies differ based on out-of-pocket expenses the firm spent handling the claim. Some could charge for these costs. They should explain their payment structure during your free initial consultation.
A contingency fee agreement works well for workers’ comp cases for many reasons, including:
- Any injured worker can hire legal representation.
- Those who need help with these claims generally have no income at the time.
- It ensures the attorney is dedicated to obtaining the best possible outcome for their client.
- There are other financial priorities for injured workers fighting to get workers’ comp benefits.
Many states cap fees in workers’ compensation cases. If you live in one of these states, your attorney may only charge you the percentage allowed under law or up to the amount dictated by the applicable statute.
A Local Workers’ Comp Legal Team Can Explain Your Options
When you suffer injuries and cannot work, the last thing you want to worry about is how you will pay your bills or cover the cost of your treatment. Workers’ compensation insurance should pay for medical bills and a portion of lost income for covered workers. However, getting approved for these benefits is often more difficult than it should be. Many injured workers must fight for their workers’ comp benefits. Reach out to a personal injury lawyer.
As soon as you learn about the denial or run into another issue with your workers’ compensation claim, you can contact a law firm that handles these cases near you. A good option is to let a professional assess your case and determine your options. Most law firms offer free initial consultations for workers hurt on the job.