If you suffer a work injury, your employer most likely carries workers’ compensation that provides benefits for employees injured in the workplace. When you suffer an injury, both you and employer must file a workers’ compensation claim immediately – often within days. In most cases, the claim is approved and employee received benefits within 60 days. However, even if your claim is valid, an examiner may review your claim and deny it for many reasons. If this happens to you, you need a Richmond workers’ comp attorney to review your case to find the reason for the denial.
Common Reasons for Denial
If your workers’ compensation claim is denied, you will receive a letter stating the reason for the denial, which can include:
- the injury did not occur at work;
- lack of evidence;
- a pre-existing condition;
- the claim was not filed timely;
- suspicion of fraud; and
- your employer denied the claim.
Some insurance examiners make honest mistakes and sometimes deny claims incorrectly. However, because approving a claim means increased liability and expenses, some insurance companies will look for any reason possible to deny your claim. If an insurer acted in bad faith and denied your claim, you should contact a Richmond workers’ comp attorney to determine your next steps.
What happens next?
Find out why your claim was denied and rectify the situation. You may need to provide evidence to support your claim, depending on the reason for the denial. For example, an employer may refuse to file a claim or deny your claim completely by stating that the injury did not happen at work. Evidence in this case may include photos of the job site, witness accounts or doctor statements.
Some states may not allow you to file a workers’ compensation claim for a pre-existing condition. It may be allowed in some states if your work environment worsens the condition to the point where you no longer can work.
Be sure you are claiming a work injury. You can file a workers’ compensation claim only for injuries that happen at work. Generally, you cannot claim any injuries that occur during your commute to and from work. You also cannot claim any injuries that happen on your lunch break because lunch breaks are unpaid and not taken on company time.
Sometimes evidence is all you need to get a claim approved. However, if you are having problems with your employer approving your claim, you should file an appeal. The appeals process varies in each state. Laws often vary as well, so it is critical to get help from an experienced Richmond workers’ comp attorney.
The Appeal Process
If you appeal the denial, your next step likely is a hearing with an administrative law judge. The judge will ask you questions about your condition. If your workers’ compensation claim still is denied, you can continue with the claims process. You typically will need to file the claim with the U.S. District Court at the federal level. Have a Richmond workers’ comp attorney help you with the process. Appeals are complex, and the timelines are often short.
Contacting a Richmond Workers’ Comp Attorney
If you get hurt on the job, you have certain legal rights. However, even if your claim is valid, it still may be denied for various reasons. Get help from a Richmond workers’ comp attorney. He or she can help you apply for workers’ compensation and make sure that you get the benefits you deserve.
If you live in Virginia, contact the Injured Workers Law Firm. We have more than 20 years of experience handling workers’ compensation claims. Contact us today at 804-755-7755 and order her free guide Ultimate Guide to Worker’s Compensation in Virginia.