Going through the workers’ compensation process can be confusing, stressful and frustrating. This is especially true if you receive a denial. Failure to receive your monetary benefits to cover your medical bills and wage losses puts you in a financial bind.
But do not lose hope. Just because the insurer does not pay your benefits after the first try does not mean that is the end of the story. Even if your claim undergoes a denial, you may still be able to obtain compensation. You have the right to challenge a denial of benefits. Here are some suggestions on what to do about a denied claim.
Understand the reason for the denial
The first step to take is to review the letter you receive from the insurer. It should lay out the reasoning for the denial. Common reasons for denied claims include:
- The injury not being work-related
- Missed deadlines
- Inaccurate paperwork
- Insufficient medical records
Once you understand the reason, you are in a better position to effectively challenge the decision.
Explore your options
With the help of a legal professional, you can figure out the best route for disputing the denial. One method is to directly discuss the issue with the claims adjuster via a phone call. Another option is to speak with a specialist from the Department of Labor and Industry about alternative dispute resolution – this can lead to mediation.
Of course, you can also consider appealing the denial by filing a claim petition form. This document informs the insurer you are legally challenging the decision and requesting a hearing.
It is important to note that, if you work in the construction industry or are part of a union, you may have to follow other procedures for resolving workers’ compensation disputes. If this is the case, you may need to talk to your union representative or employer.