A workers’ compensation claim denial can cause injured workers a lot of grief, anger, and confusion. Insurance companies may deny a claim for several reasons: reasons that most injured workers would likely disagree with. A denial should not, however, cause injured workers to despair. It may seem counter-intuitive, but a denial doesn’t mean the end of your workers’ compensation claim. Even after a denial of benefits, injured workers have the option to appeal their denied claims to the Workers’ Compensation Appeals Board (WCAB). And according to research, 2 out of every 3 workers who appeal their denied claim ultimately received benefits.
Injured workers who have had their workers’ comp claim denied should immediately contact a qualified workers’ compensation law firm. We suggest immediately because there are specific deadlines that must be met in order to pursue an appeal. The workers’ compensation appeals process is complicated, but an experienced attorney can help you collect the appropriate evidence and file all paperwork on time. Specifically, a Petition for Reconsideration must be filed with the WCAB within 20 days of receiving a claim denial (25 days if the denial was sent by mail).
Workers’ compensation claims can be denied for many reasons, but some of the most common reasons are lack of medical evidence, preexisting conditions, failing to report the injury, or lack of an injury at all. A denial will often be reversed upon appeal by providing the proper documentation. Lack of medical evidence? Provide the insurance company with the medical evidence documenting your injury. Preexisting condition? Provide the proof and documentation that shows your work injury aggravated the original injury or was separate from your old injury altogether. Failure to report the injury? Provide proof that the business was aware of your injury when it occurred. A skilled attorney can help you find the appropriate evidence and present it in the best possible way to reverse your denial.
Filing an appeal to WCAB will not necessarily result in a hearing and judgment. Insurance companies, when provided the new evidence countering their initial denial, may wish to settle your case. Your attorney will negotiate a settlement on your behalf, often resulting in a greater benefits award than had your initial claim simply been accepted. According to research by Lockton Analytics, initially accepted claims averaged $10,153 in benefits. Initially denied claims averaged $15,684 in benefits, a nearly 55 percent increase.
It’s important to note that every legal case and insurance claim is unique and there is no guarantee of success when appealing a workers’ compensation denial. The Law Offices of Scott Warmuth offers workers’ compensation legal services on a contingency fee basis. If we are unsuccessful in appealing your workers’ compensation claim denial, you will not owe any attorney fees. For a free legal consultation, call us today at 888-517-9888.