If you are going to try to collect compensation for a work injury from your employer’s insurance company, don’t expect everything to run smoothly. These insurance giants didn’t become profit monsters by approving every single claim that comes across their desk, and they’ll look for any reason to deny part or all of your claim. So what types of aspects of your claim could be denied, and what should you do if you receive a denial letter from the insurance company? We answer those questions and more in today’s blog.
Common Types Of Denials In Work Injury Cases
As we mentioned above, the insurance company will look for any reason, big or small, to deny your claim or limit their liability. Some common types of denials that we see when employees attempt to file their injury case on their own include:
Denial or Discontinuance of Wage Loss Benefits – The insurance company may argue that your injuries do not qualify you for wage loss benefits, or they may issue you a Notice of Intent to Discontinue Benefits at some point down the road. If the insurance company is trying to prevent you from collecting wage loss benefits in the wake of a work injury, you need to consult a lawyer to learn about your options.
Denial of Medical Bills – Your employer’s insurance company is legally required to pay for medical bills that you incur as a result of your work injury. However, don’t be surprised if they argue that some expenses are elective or not necessary as part of your standard care. If they are arguing that you received medical care that went beyond the scope of your injuries, talk to a lawyer. It may simply be a misunderstanding of facts, or it could be an attempt to get out of paying their fair share.
Denial of Surgery – If you need surgery following a work injury, the employer’s insurance company is required to pay for these costs. However, they may dispute whether or not that level of medical care is needed. Many medical professionals try to address injuries with conservative techniques and view surgery as a last resort, but that doesn’t mean that the insurance company will view your operation as a necessary expense. If they believe it’s elective in nature or unrelated to your original work injury, they may deny surgery costs prior to or after the procedure.
If you receive any of these denials or another denial related to your work injury case, it is in your best interest to contact a workers’ compensation lawyer like Dean Margolis. We have extensive experience filing successful claims so you can avoid a denial in the first place, and we’ve won countless denial cases when arguing our merits before a judge.
Insurance companies hope that you take their denial at face value and just accept their decision, but you can always argue your case before a third party. The insurance company does not have the right to issue a full and final decision, so don’t let them deny you compensation you’re rightfully entitled to receive. For assistance with any part of your work injury claim, or if you’ve recently received a denial letter from your employer’s insurance company, reach out to Dean and the team at Margolis Law Office today.
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