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What should I do if my workers’ compensation claim has been denied?

In every state, most employers are legally required to carry work comp coverage. This insurance protects workers who are injured on the job and those who get sick from exposure to something in the work environment. For a variety of reasons, workers’ compensation insurance claims are often denied. However, that doesn’t mean that injured workers are out of options.

Why Are Work Comp Claims Denied?

The laws applied to workers’ compensation claims vary by state. Every state has deadlines and requirements. The insurance company can use those to deny your request.

  • Failure to report an on-the-job injury to the employer promptly is one of the most common reasons for claims denial. You must report your injury immediately or as soon as reasonably possible. In some states, you only have a few days to do this.
  • Failure to file a claim promptly is different than reporting the injury. Each state has a deadline for how long you have to submit your application to the state workers’ compensation administrator.
  • Claims are often denied if there is a question about whether the injury happened at work while you were on duty. If you are injured while on a lunch break, the policy may not provide coverage.
  • A work comp claim may be denied if the insurer thinks you might have been under the influence of alcohol or drugs at the time of the injury. If you are impaired by prescription medication, this may result in your claim being denied.
  • The insurance company may deny your claim by arguing that your condition is not work-related or that it was pre-existing. An insurer may even accuse you of faking your condition.
  • Some states don’t cover specific categories of injuries, such as repetitive motion conditions. Mental health claims are often denied because it is difficult to tie them to the job or work environment. However, most states do provide coverage for conditions related to a particular event, such as post-traumatic stress disorder, and those that emerge over time, such as depression.
What Can I Do if My Workers’ Compensation Claim is Denied?

You have the right to appeal if your work comp claim is denied. The letter from the insurer should detail precisely why the request was rejected along with instructions on how to appeal. Depending on your state, you should have from 30 to 90 days to file the appeal. The best way for you to protect yourself is to contact an experienced and knowledgeable workers’ compensation attorney, like one of the workers comp lawyers in Milwaukee, WI from Hickey & Turim, SC, who is familiar with the laws in your state.

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