So, you were denied workers’ compensation?
Don’t sweat it. A denial of your claim isn’t the end of the line for you. In fact, it may come as a shock to you when you find out this little secret…
On average, 1 out of every 5 workers compensation claims get denied in the United States.
That sounds bad, but the good news is that this doesn’t have to be you.
But, here’s the thing: you can win the appeal with the right strategy.
This article will show you how to do that.
Here’s a look at what’s coming up:
- Why Your Claim Got Denied (And What To Do About It)
- The Workers’ Comp Appeals Process Decoded
- How To MASSIVELY Improve Your Chances of Success
- When You ABSOLUTELY Need Legal Help
Why Your Claim Got Denied (And What To Do About It)
First of all, in order to prepare yourself to win the appeal, you must first understand WHY the claim was denied.
Here’s the real reason:
There are only a few basic reasons for denial:
- You reported your injury late.
- The insurance company says your injury did not happen at work.
- You did not have enough medical evidence.
- The injury is not new and you have a pre-existing condition.
In their “defense,” you should know each of these things is easily overcome.
Late reporting, for instance, can be excused if there was a good reason why you didn’t know the injury was work-related. See? Reasonable, right?
The solution in all these cases is the same. You have to build a strong, undeniable case that refutes the reason for denial.
The Workers’ Comp Appeals Process Decoded
Think that the appeals process is a big confusing deal? It kind of is, but not once you understand it.
Here’s the lowdown on how it goes:
Appeals are only valid if they are submitted within 14 – 30 days after the denial. This time frame differs from state to state, so don’t delay.
Appeals hearings are usually held by an administrative law judge. These are less formal than traditional courtrooms, but the judge’s decision is just as binding.
During this hearing, you will have the opportunity to present your evidence and testimony to prove your case. This is where you get to shoot your shot, so to speak.
Your evidence may include:
- Medical records and expert testimony
- Witness statements from coworkers
- Proof of work duties and conditions
- Documentation that rebuts the denial reason
If you’re facing an uphill battle or a particularly complicated case, this is the point where you want to make sure you have legal help from a workers comp lawyer out of Fresno.
If you are unsuccessful at this hearing, you can often appeal to a higher administrative board, and ultimately the state’s civil court.
In fact, here’s a shocker for you…
Statistically, claimants with attorney representation are 3 – 5 times more likely to succeed in their appeal hearing than those without a lawyer.
Crazy, huh?
Ok, so now you’ve got a little more info under your belt.
Let’s talk about what you can do to make sure your appeal is successful.
How To MASSIVELY Improve Your Chances of Success
Alright, so here are some common threads among successful appeals.
Get Your Medical Documentation Spot-On
This is where the vast majority of people drop the ball. When you file for workers’ comp, it’s not enough to simply have a doctor say you were hurt on the job.
Here’s what you need instead:
- Detailed medical records that clearly link your injury to your work
- Treatment notes that document the progression of your condition.
- Expert medical opinions that support your claim
- Any diagnostic tests that show the extent of the injury.
Don’t just rely on your family doctor. Sometimes you need a specialist to provide a more authoritative and convincing opinion about your injury.
For instance, if you hurt your back at work, you may need an orthopedic specialist to examine you and explain exactly how the injury happened.
Get Witness Testimony
Coworkers who saw the accident happen can provide key testimony to the hearing. If someone witnessed the accident, or at least can confirm your version of events, this can be incredibly valuable evidence.
But, you have to get those witness statements while the memories are still fresh, people. Don’t wait too long.
Document Everything
Keep a paper trail of:
- All medical appointments and treatment
- Time off work due to injury
- Daily life activities affected by the injury
- Conversations with your employer or insurance company
Follow Your Treatment Plan Religiously
Insurance companies absolutely LOVE to deny workers compensation claims on the basis that workers did not follow the treatment plan prescribed by a doctor.
You better believe they will try to argue you are faking your injury if you aren’t keeping up with physical therapy or going to your doctor appointments.
So even if your treatment is not helping, keep on it anyway.
Appeals board is more likely to believe your claim if you demonstrate a strong effort in following medical advice. It shows you are serious about recovery and returning to work.
When You ABSOLUTELY Need Legal Help
This one is kind of a no-brainer.
You want professional legal assistance in these situations:
- The claim involves complex medical issues.
- The insurance company is using surveillance against you.
- You have been retaliated against by your employer.
- The case is for a large amount of money.
- You have lost an appeal in the past.
Here’s the thing about why this is so important:
Appeals have deadlines and procedural requirements you absolutely must follow.
Miss a deadline or file the wrong paperwork at the wrong time and you can lose your rights to benefits forever.
An experienced workers comp lawyer is going to know how to navigate this process. They also know what evidence appeals boards are looking for in your case.
Also, a big bonus is that most workers compensation lawyers work on a contingency basis. That means you don’t have to pay unless you win.
The Insurance Company Has Lawyers, Why Shouldn’t You?
Let that sit for a minute.
The insurance company that’s denying your claim has some top-notch attorneys that are fighting tooth and nail to keep that money in their pockets.
They know ALL the tricks in the book to minimize or deny a valid claim.
They will look for ANYTHING to come up with an argument that you are not entitled to these benefits.
So, you are going to be up against some professional lawyers that have your money as their motivation for fighting you tooth and nail.
And all you are going to have on your side is what, a paralegal?
If you think about it, you have absolutely nothing to lose by hiring a real Fresno workers comp lawyer to fight for you.
Your case may be that one that tips the scales. With the right preparation and strategy, there is no reason you can’t win that appeal.
