When an Oklahoma worker sustains in injury on the job, workers' compensation should cover the damages. This is true regardless of who is at fault for the incident, which is one way in which workers' comp claims differ from standard personal injury claims. However, though workers' compensation is a no-fault system, there are instances in which claims get denied. When this happens, the injured party has a few options, one of which is to file an appeal.
Why Your Claim Was Denied
Before you file an appeal for the denial of your workers' compensation claim, it is important to first understand why your claim was denied. The workers' comp insurer should have explained the reason in the denial letter. Some reasons for denial are legitimate, such as "the worker was engaging in horseplay," while others are fishier. An experienced workers' compensation lawyer can help you examine the denial letter, determine if the denial is legitimate, and decide how to proceed from there.
Some common reasons for denial include the following:
● You did not report the injury in time;
● You did not file your claim on time;
● Your injury is not-compensable (e.g., you claim stress as a work-related injury);
● Your employer has disputed your claim;
● You did not receive the recommended medical treatment; and
● You do not have sufficient evidence that your injury is work-related.
Unless you did not report your injury or file your claim on time, or unless you did not receive the recommended medical treatment, you may have a good shot at reversing the workers' compensation company's decision through an appeal.
Appealing Your Workers' Compensation Denial
Once you understand the insurer's decision for denying your claim, ask your workers' compensation lawyer to help you appeal the decision. Your denial letter must contain precise information and be formatted in a specific way, which is why it is imperative you allow an experienced attorney to help you draft it. You also need to file the appeal notice by a certain deadline, which is generally 30 days from the date you received the denial letter.
The appeals process generally involves going before an administrative law judge to make your case. You want to be prepared before the hearing and arm yourself with medical records, witness statements, a timesheet showing that you were working at the time of injury, and any other evidence you feel would corroborate your case.
Why Hire a Workers' Compensation Lawyer
Though you may feel confident in your case, if you received one denial, chances are, without the proper legal representation, you will receive a second. A knowledgeable workers' compensation attorney can help you prevent a second denial by guiding you through the appeals process and advising you of what you should and should not do. To begin the appeals process, contact BDIW Law today.