Your Workers’ Comp Claim Was Denied. What now?

The denial rate for workers’ compensation claims has increased significantly in recent years. The most likely reason for the increase is the desire by employers and their insurance companies to lower costs. Many of these employers are discovering that the strategy does not work. Increased denials have actually led to higher claims costs.

If you are an injured worker and your claim has been denied, you may be dealing with the high cost of medical bills combined with the fact that you have lost wages because your injury has kept you off the job. When faced with a claim denial under these circumstances, do not lose hope. You may still be able to collect benefits if you follow the right steps.

Reasons Why You Might Be Denied Workers’ Comp

There are several reasons why a workers’ comp claim could be denied, in whole or part.  The precise reason will be described in the denial letter. Reasons for a workers’ comp denial include:

• The worker failed to report the injury in a timely manner.  If you have suffered an injury on the job, you are required to report your injury and should do so as soon as possible.
• The injured worker failed to file the claim prior to the deadline. Injured workers must file a claim before the deadline is up according to Kentucky Workers’ compensation law.
• The employer has a dispute with the claim. For example, the employer may claim that the injury was not suffered on the job. They may claim that the injury was pre-existing or they may concede that the injury was suffered on the job, but say that the worker’s irresponsibility was what caused them to get hurt.
• The specific injury or condition is not eligible for compensation.
• The worker failed to follow medical advice.
• The worker refused to return to work even after they received approval to do so from a physician.

After the Denial

If your claim is denied, you will need to present your claim to an Administrative Law Judge for determination, through a formal “Application” process.  This procedure, administered through the Kentucky Labor Cabinet, can be complex and confusing.  Accordingly, it is strongly recommended that you have an attorney represent you.

Workers’ Compensation Denial Appeals

A hearing before an administrative law judge is the first part of the process. The judge will determine whether there is adequate evidence to support your claim. Thereafter, if your claim is denied by the judge, there are levels of the appeals process that you can pursue.  For example, the Kentucky Workers’ Compensation Guidebook states that you may appeal to the Workers’ Compensation Board if you receive an adverse decision from the judge.  It is important to understand that the appeals process involves some strict deadlines. Your attorney can help you to meet those deadlines.

At Saladino & Schaaf, we have years of experience representing Kentuckians in workers’ compensation lawsuits. If you’ve been injured on the job, contact us online or at (270) 444-0406 to schedule a free consultation today. You may be entitled to significant compensation, but the clock is ticking.