If you’re trying to file your workers’ compensation claim on your own, or even if you’re working with an attorney, it is not uncommon to have your initial claim denied by the insurance company. That doesn’t mean you don’t have a valid claim, but you may have to change a few things. Below, we take a look at why your claim may be denied, and how you can earn compensation after an initial denial.
Why Was My Work Comp Claim Denied?
Here’s a quick look at the most common reasons why someone may have their initial claim denied. The below percentages were taken from a workers’ compensation survey.
Pre-existing condition – This was the most common reason someone’s claim was denied, as 28 percent of denials were for a pre-existing condition. Even if a pre-existing condition existed, you can still prove that you have a valid claim, so don’t give up after an initial denial.
Failure to meet deadlines – 13 percent of denials were for missed deadlines. Typically you have time limits to inform your employer of your injury and to file your claim. An attorney can help you avoid missing these deadlines or file a motion to excuse your missed deadline if you have a valid reason.
Off-Duty or Off-Site Injuries – Five percent of respondents said their claim was denied because they were deemed to be off duty at the time of your injury. Again, working with an attorney can help you prove that your actions fell in the line of your work duties.
Other – Roughly half of the denied claims listed “other” as the main reason for denial. For example, some insurance companies may deny that the injury took place or that it wasn’t serious enough, while other people were not given a direct answer for why their claim was denied. If this happens to you, lawyer up and fight for your rights.
Winning A Claim After An Initial Denial
So what are the odds that you can earn compensation if your initial claim was denied? You’re probably thinking your chances are slim, but the study results suggest differently. According to respondents, roughly half (47%) of individuals who had their first claim denied eventually earned compensation or a settlement.
How do you go about winning a claim after an initial denial. Well for starters, as you might have guessed by reading the above reasons for denial, your best bet is to hire a workers’ compensation attorney. They can handle filing a challenge to the denial, but that’s just the beginning. The study suggests that 82 percent of people who won a claim after an initial denial did so by reaching a settlement with the insurance company, and only 18 percent won their case by going before a work comp judge. This doesn’t mean you’re less likely to win in front of a judge, but usually the injured party and the insurance company can come to an agreement during a settlement conference.
If you go to a settlement hearing, you’ll want an expert by your side to argue your case and get a fair deal from the insurance company. If you’re by yourself, expect a lowball offer or to be bullied into accepting. Don’t ever sign anything or agree to a settlement without an attorney, because it can cost your thousands of dollars. We’ll hammer home this point by once more looking at the study.
After a denied claim, injured workers who eventually earned a settlement without the assistance of a lawyer earned an average compensation award of $12,400. Conversely, individuals who eventually earned a settlement award after an initial denial who worked with an attorney received an average settlement of $18,200, or $5,800 more than those who earned compensation on their own. This would more than offset the cost of a lawyer.
If you’ve been denied or just want to ensure your initial claim has the best chance of being approved, reach out to Dean Margolis today.
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