Every worker’s compensation claim is subject to evaluation by the insurance company. While it is your legal right to seek compensation following a workplace injury, it is important to note that insurers also have the authority to deny your workers’ compensation claim.
The good news is that there are ways to dispute this denial to seek the benefits you rightfully deserve.
Know the reason for the denial
When disputing a denied workers’ compensation claim, you must first understand the reasons behind the insurance company’s denial. They should give you this information in their denial notice or over a phone call. Knowing why can help you address the specific issues that led to the denial.
Talk with the insurance adjuster
Once you understand the reason for your claim denial, your next step is to contact the insurance claims adjuster. Often, they deny a workers’ compensation claim due to discrepancies in a worker’s medical records or issues with the claim form. You can address these issues by supplying additional documentation or clarifying any misunderstandings about the denial during a phone call.
A clear and concise explanation of your issue can help resolve misunderstandings and may even lead to a resolution.
See an alternative dispute resolution specialist
If talking with the claims adjuster does not resolve the issue, you can reach out to an Alternative Dispute Resolution specialist. The Department of Labor and Industry (DLI) provides these specialists to help you through the dispute resolution process and assist claimants like you in understanding the complexities of their denial. Their guidance can help in resolving your issues.
Consider legal assistance
If you are still facing issues after taking the above steps, it might be time to consider seeking an attorney. While it is hoped that disputes can be resolved without legal intervention, sometimes it is necessary. Consulting with an attorney can give you the advice and direction you need to move forward.
Remember, every case is unique. So, seeking a legal professional can provide help tailored to your specific circumstances.
