What To Do If You Receive a Workers’ Compensation Claim Denial

It can be frustrating to suffer an injury at work only to receive a workers’ compensation claim denial. If you are wondering what to do if you receive a workers’ compensation claim denial, why it was denied, or how to make your case stronger for an appeal, contact an experienced workers’ compensation attorney at Tyroler Injury Law today by calling (651) 259-1113 for a free case evaluation.

Workers’ Compensation Laws

In the United States, employers are legally required to provide workers’ compensation insurance for employees who suffer injuries or illnesses in the course of their employment. These laws are established to prevent someone who has been injured at their job from potential financial struggles resulting from their inability to generate an income if injured.

To determine if you have a valid claim for workers’ compensation, you must satisfy any requirements that are set by the state in which you reside. In Minnesota, workers’ compensation is covered under Chapter 176 of the Minnesota Statutes. Alternatively, in the state of Wisconsin workers’ compensation is covered under Chapter 102 of the Wisconsin Statutes. If you have been injured in either Minnesota or Wisconsin and are wondering what to do if you receive a workers’ compensation claim denial, our experienced workers’ compensation attorneys can help.

Reasons Your Workers’ Compensation Claim May Be Denied

There are many reasons why a claim for worker’s compensation may be denied. These include:

  • The accident did not happen at work: If your accident occurred outside of work hours or while you were not working then your claim may be denied.
  • Your employment does not qualify you for workers’ compensation: If you are an independent contractor or temporary employee then you may not qualify for workers’ compensation if injured on the job.
  • Missed filing deadlines: You are required to report your injury and file your workers’ compensation claim if injured on the job within a specific time period. Each state has different filing deadlines but if you miss the deadline, it may be a valid reason to deny your workers’ compensation claim.
  • The type of injury you had is not covered: If you sustained an injury that does not normally happen in the scope of your job it may not be covered under workers’ compensation.
  • You intentionally injured yourself: If it can be proven that you intentionally harmed yourself while at work to claim workers’ compensation then your claim may be denied.
  • Pre-existing injuries: If your injury existed prior to you working in your job, then you will likely not have the ability to claim this on a workers’ compensation claim. However, if you had a pre-existing injury that was worsened due to a work injury, you may have a worker’s compensation claim. Visiting with an experienced workers’ compensation attorney can help you understand your legal rights.
  • No witnesses and/or facts of the injury are vague: If there is any doubt about how the injury occurred when the injury occurred, or if there is no one to verify that the injury occurred as claim, then there is a possibility that an employer can deny the claim.
  • You were under the influence of drugs or alcohol at work: If your injury is at all related to being on drugs or under the influence of alcohol while at work when you were injured then your workers’ compensation claim may be denied.
  • Delaying notification of a claim: If you are injured at work and you do not let your employer know of the injury immediately, you run the risk of showing that the injury was not serious or that you were not actually injured.

What To Do If Your Claim Has Been Denied

If you receive a denial of your workers’ compensation claim, consider the following steps:

Visiting with the Worker’s Compensation Claim Representative

If you are wondering what to do if you receive a workers’ compensation claim denial, the experienced workers’ compensation attorneys at Tyroler Injury Law can help you determine your next steps. In most cases, you will receive a letter stating why the claim was denied. If it was simply an administrative matter that can be easily resolved, you may be able to do so directly by speaking with the workers’ compensation claim representative. However, this is not typically the case, and visiting with an experienced workers’ compensation attorney can help you understand how you may have the legal right to file an appeal.

Filing an Appeal

A denial letter will also include information on how to apply for an appeal. The appeals process for workers’ compensation claims will vary based on your state. It is important to pay attention to any timelines or deadlines noted in a denial letter to ensure that you are filing the appeal in the appropriate time-frame.

Filing an appeal can be a complicated and lengthy process. Contacting an experienced attorney can help. Our attorneys can advise you on all of the legal options available to you if your claim for workers’ compensation has been denied. The Tyroler Injury Law legal team can walk you through potential appeal options should you decide to pursue the compensation you deserve under the law.

Mediation and/or Administrative Hearing

Once a workers’ compensation appeal has been filed it is common for both parties to participate in mediation first to try to settle a case without formally going to court. If you participate in a mediation, it will be with a third party who is neutral. The mediator’s role is to get both sides to agree on a conclusion that works for both parties. Mediators cannot make a final decision unilaterally and cannot force a decision upon the parties like a judge.

If the mediation fails to come to a resolution, you may wish to have an administrative hearing in front of an administrative judge. You will have the burden of proof to show that the denial of the workers’ compensation claim was incorrect. Should you decide to move forward with an administrative hearing you may consider contacting an experienced attorney. Our workers’ compensation attorneys can guide you through the hearing process and help you build the strongest case possible in support of your case to reverse the decision to deny your claim.

Additional Appeals

If you pursue an administrative hearing a decision will be made that will be final. Depending on the state you live in you may have access to additional appeals processes. If you are unsure of how to move forward, contact us today. We can help you determine any additional options that may be available to you.

Contact an Experienced Workers’ Compensation Attorney Today

The attorneys at Tyroler Injury Law can help determine options that are available to you if you are wondering what to do if you receive a workers’ compensation claim denial. After an injury has occurred, recovery and rest should be a high priority. While you focus on healing our attorneys can help form your legal strategy and discuss options available to you if your claim was denied. Contact us today at (651) 259-1113 to learn more.

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