What if a COVID-19 claim was denied?

| Aug 18, 2020 | Workers' Compensation

Workplace injuries are supposed to be covered by the company’s worker’s compensation insurance. It is usually the law that the employer has it, so there is rarely an issue of no insurance. However, claims may be denied for any number of reasons. While this is grounds for great concern, a denial is not the final decision, even in cases involving COVID-19.

Why it happened

Denials or benefits of a lesser amount are often caused by mistakes in paperwork, missed deadlines, or insufficient evidence that the illness involved work. In the latter case, the employer or the insurance carrier may refute the claim, arguing that the worker was not exercising proper precautions to avoid transmission of the virus or that a family member infected them. The insurer will send a Notice of Insurer’s Primary Liability Determination form, which should clearly outline the facts and reasons for why they denied the claim

Appealing the decision

Workers can call the insurance claims adjuster to get more information. At this time, the employee can try to explain the circumstances in greater detail. The next step is to take up the case with an Alternate Dispute Resolution specialist provided for free by Minnesota’s Department of Labor and Industry.

If that is unsuccessful, the worker can file an Employee’s Claim Petition form with help from an attorney. This process is complicated, so workers will often benefit greatly from the guidance of lawyers who handle worker’s compensation cases here in Minnesota. These legal professionals can help to effectively prepare documents, meet deadlines and argue the case during these proceedings.