When you have been hurt on the job and need to take time off to recover, your workers’ compensation medical and income replacement benefits become extremely important. These benefits can be the lifeline your family needs to stay afloat until you can return to work.
Unfortunately, insurers reject some injured employees’ claims or stop their benefits prematurely. And many of these denials are certainly not justifiable. If the insurer has recently denied your claim, do not lose hope or accept what the insurance company is telling you. You are legally entitled to appeal the denial and attempt to prove your claim.
Work with a workers’ compensation attorney for help with the appeal. We know how to help you collect the evidence necessary to justify your benefits and how to present it convincingly at the appeals hearing. For a lawyer that assists with appeals in Savannah, call the Bader Law Firm at 678-562-5595.
What are some common reasons claims are denied?
First, if you do not meet the basic qualifications for workers’ compensation, the insurer will obviously deny your claim. The baseline prerequisites are that:
- You are an employee
- Your injury is work-related
Those being satisfied, you must also abide by the rules for filing workers’ compensation claims, or the insurer could likewise deny your claim. Oftentimes, insurers reject claims simply because of administrative errors, such as failing to notify the employer on time, failing to submit the claim on time, and not providing the insurer’s or State Board of Workers’ Compensation (SBWC) requested documentation.
In many cases, though, insurers wrongly deny claims on other bases. Some of the top reasons for denials that we have witnessed include the following.
- Independent contractor – Only employees, not independent contractors, are eligible for workers’ compensation. Sometimes the employer or insurer will try to label the worker as a contractor, when she is actually an employee.
- Injury is pre-existing – The injury must also have occurred on the job, in the course and scope of work duties, or because of job-related conditions in order to qualify a claim. Insurers often deny claims by saying that the injury was pre-existing or not related to the job at all, and hence not compensable under workers’ compensation.
- Intoxication – Workers’ are ineligible for workers’ compensation if they were intoxicated at the time of injury. If the employer asserts that the employee was intoxicated, the insurer may deny the claim.
- Illegitimate injuries – Employers/insurers routinely hire private investigators to conduct surveillance to monitor claimants during the claims process. If they catch you doing something that your injury supposedly prohibits (e.g., picking up groceries even though you are out of work with a back injury), they may use the surveillance as evidence to refute your claim.
- Statute of limitations – Some insurers may deny your claim by alleging that you violated the statute of limitations, or time limits in which you have to file your claim or take action. However, if the insurer alleges you did not file on time, talk to us to review your case to see which time limit applies to you. It may be anywhere between one and four years depending on your circumstances.
Can I appeal a workers’ compensation denial?
It is frustrating, to say the least, when you have a legitimate claim, you need your benefits now, and yet the insurer has denied your claim. If this happens, you will get a letter in the mail stating the reason for denial. Note, at this point, you will want to take action quickly because there is a time limit on when you can request a hearing with the Administrative Law Judge (ALJ).
Your first step will be to contact an attorney for help preparing your case for the hearing with the ALJ. Your attorney can request a hearing, which is essentially your opportunity to ask for a reversal of the denial. You will then need to gather a lot of evidence that specifically counters the insurer’s reasons for denying your claim in the first place.
Can Bader Law Firm help me with my court hearing and appeal?
Bader Law Firm helps injured workers in Savannah successfully resolve their workers’ compensation cases whether they hire us at the start of their claim or after the insurance company denied their claim. If your claim has been denied, call our office and speak to one of our attorneys. We can review your case and determine how best to approach your hearing and build your case.
Should you work with us, we will serve as your legal advocates during the hearing process and fight for the full amount of benefits to which you are entitled. Contact us today at 678-562-5595 for a free consult in Savannah.