What do I do if my workers’ compensation claim is denied?

If you receive a letter from the workers’ comp insurance company you are dealing with that states they are delaying or denying your claim, you are most likely shocked and disappointed. You probably also have a lot of question like what your options are and what you should do next. The good news is that just because you received a letter stating that your workers’ compensation claim has been denied, it is not the final decision on whether your claim will ultimately be approved.

It is not uncommon for an insurance adjuster to find some basis for denying or delaying your claim. Often insurance adjusters will claim an injury did not occur at work or that you were not an employee at the time of the injury. If you do nothing after you receive a letter of denial for your workers’ compensation claim, the insurance company’s decision will be final.

If you do not agree with the denial you should consult with a workers compensation attorney. A workers’ comp lawyer will assist you in filing an “Application for Adjudication of Claim” with the Workers Compensation Appeals Board. A skilled and experienced workers’ compensation claim attorney may be able to negotiate a favorable settlement with the insurance company. Although it is not required that you be represented by an attorney in workers’ compensation claim matters, it is highly recommended in order to obtain the most favorable outcome.

If you received a letter of delay, it is likely because the insurance company is requesting more information. Under several circumstances, a claims adjuster may request that you been seen by a qualified medical examiner for further evaluation. They may provide you a list of doctors to select from. Most experienced workers’ compensation claim attorneys are familiar with the doctors and will be able to assist you in selecting a QME based on your particular circumstances.

It is important to remember that workers’ compensation claims adjusters are required to conduct a “good faith” investigation into the facts and circumstances of your workers’ compensation claim. This requires that they do more than just read over facts. They must evaluate and weigh the facts that are presented to them. When they are provided with information from your employer or another individual that may hurt your claim they will fully investigate it.

If you have been injured on the job and your workers’ compensation claim has been denied, then consult with a workers’ compensation attorney who will be able to provide you answers to your questions and assist you in getting the workers’ compensation that you may be entitled to. Call the workers’ compensation  claim attorneys at Robbins, Strunk & Cramer at 408-763-8336 to discuss your on the on the job injury and workers’ compensation benefits.