Workers’ Compensation Denied Claims

Workers’ compensation insurance is typically used to cover workplace injuries. Many states mandate that employers be insured in accordance with the industry’s average level of risk. However, if your workers’ compensation claim is denied, you still have options. You may be able to appeal the denial to the workers’ compensation board in Iowa. A claim maybe denied for a variety of reasons.

If you have filed a workers’ compensation claim and it has been denied, you should seek legal advice from an experienced workers’ compensation attorney. Schedule a free consultation with the law firm of Mueller, Schmidt, Mulholland & Cooling to discuss your denied claim. Our Des Moines workers’ compensation lawyers are here to help you.

Common Reasons for a Denied Claim

If your workers’ compensation claim was denied, the first thing you should do is figure out why. You will receive a detailed reason why your claim has been denied in your denial letter. You could be turned down if you don’t match the eligibility conditions, such as being injured while messing around (horseplay) or away from work. However, if you believe the refusal was made in error, you have the right to appeal. The following are some of the most common reasons for a denial of workers’ compensation benefits:

• Missed Deadline: It can be a problem if you don’t report your injuries right away. If you are injured on the job or notice that you have developed a work-related sickness or condition, you must immediately contact your supervisor. In Iowa, you have 90 days to notify your employer of a workers’ compensation claim. Failure to do so may jeopardize your eligibility for assistance and/or benefits.
• Injury Dispute Workers’ compensation claims for cumulative trauma or psychological problems may be subject to additional limits under Iowa law. Workers’ compensation benefits may not be available for illnesses induced by long-term emotional stress at work. Alternatively, your injuries may not be serious enough to qualify for a workers’ compensation claim.
• Non-work Related: Your boss may claim that you weren’t working at the time of your work injury, that you were engaged in some form of wrongdoing at the time, or that your present medical condition isn’t the result of a workplace accident or exposure. Whatever the reason for the disagreement about whether your disability or illness was caused by your job, you’ll need to gather proof to back up your claim.
• Employment Status: Claims filed after an employee has been fired, laid off, or quit are frequently denied by insurers. However, there’s a chance you have a valid explanation for the delay. Perhaps you were hurt while still at work, or you were hurt after you gave (or were given) notice but before your last day. Perhaps you were fired for reporting a workplace injury in retribution (which is illegal).

Your workers’ compensation claim could have been refused for a variety of reasons. If you believe you were wrongfully denied for whatever reason, you will have the opportunity to appeal the decision.

What to Do When Your Claim Has Been Denied?

If your workers’ compensation claim was initially rejected, do not give up your right to benefits. First, carefully examine the letter informing you that your claim has been denied. It will very certainly include the grounds for the rejection. If you believe the problem was caused by erroneous documentation or something similar, you should contact the claims adjuster to see if you can resolve the issue. However, unless your employer or the insurance provider committed a genuine error and admitted it, this path is unlikely to succeed. You’ll almost certainly have to consider appealing the denial.

Some workers’ compensation claims are, of course, legitimately dismissed. Employees who fake or grossly exaggerate their ailments will not be eligible for benefits. Employees who were inebriated at the time of the accident and injuries may also be properly denied workers’ compensation benefits.

Filing an Appeal After a Denied Claim

You may choose to appeal the decision now that you know why your claim was refused. A timeframe for filing an appeal should be specified in the refusal letter, which is set by state legislation. In Iowa, for example, you have 20 days from the date you receive the denial notice to file an appeal. However, before filing an appeal, you should speak with your employer (or its insurance carrier) to see if the problem can be handled outside of the workers’ compensation commission. It could be a simple misunderstanding or a clerical error that will be easily resolved.

If you decide to appeal the denial, keep in mind that it is a complex legal process that should be handled by a skilled workers’ compensation attorney. The appeals process varies by state, but in Iowa, it usually entails a hearing before an administrative law judge, which can be done through the labor department or Iowa’s workers’ compensation board. There may be several levels of appeal and options on where you can submit your appeal.

Any material, including medical records, that addresses the reason(s) for the denial will be prohibited. This might include the results of a second medical examination, a timesheet proving you were working at the time of the injury, or any other evidence. However, if you intend to appeal, make sure you are familiar with the procedures. The workers’ compensation commissioner’s office has different procedures than a court.

Des Moines Workers’ Compensation Attorneys for a Denied Claim

Contact the law offices of Mueller, Schmidt, Mulholland & Cooling located in Iowa today. Our Des Moines workers’ compensation attorneys offer a free initial case evaluation. We will get started on your claim right away once an attorney-client relationship has been established. One of our experienced Iowa workers’ comp lawyers is ready to handle your case.

Our contact information can be found online, or you can call us at (515) 444-4000 The Des Moines workers’ compensation attorneys and personal injury lawyers at MSMC can help injured workers with their personal injury claim and workers’ compensation claim, or discuss benefits with the insurance company.