What if my workers comp claim is denied?
Greg and Sue, Clients
When your claim is denied, it can deal some serious damage to you and your family. Luckily, there are several options you can use to change this outcome.
When your claim is denied, you can petition your insurance provider or claims examiner to think twice about the decision. You do this through the Workers Compensation Division. Once your insurance sends a denial for compensation, you have 60 days to send in a request form to challenge the decision. Those forms can be found here.
If your insurance denies your reconsideration appeal, don’t fret. You can go the next step and consult the Worker’s Compensation Board for an appeal. Once they make a decision on your case, you can request a hearing. For instructions on how to do this, click here. You have a limited time to do this, so check the reconsideration denial letter or agency order you received.
If you are unsure how to proceed to get the best coverage, consider getting legal help from an attorney. When you appeal to the board, you will present a case, not just file paperwork. With this in mind, you’ll want a good lawyer by your side. Getting legal counsel can happen at any time during the claims process.
There may be other circumstances that affect your claim and denial process. If so, there are still things you can do.
If you still can’t return to work even after a denied claim, you may qualify for temporary benefits. These apply under certain conditions, so it may be best to consult a lawyer to know what you qualify for.
If you can’t return to work with modified duties due to your injury, you may qualify for Temporary Total Disability. If you can return with modified work, that falls under Temporary Partial Disability. To know what you best fit into, a lawyer may be needed. For more information, click here.
Sometimes, the dispute can be about your medical condition or injury that led to the workers’ compensation claim. If so, you can request to have a medical exam from a neutral source. When filing a claim, it often includes a mandatory medical exam, but not always. Your exam can impact your ability to receive coverage, so getting one is a crucial step.
If your insurance denies your claim because of Independent Medical Exam results, you can still dispute this by taking a worker-requested exam. Your attending physician must agree to this as well. If so, you have 60 days to appeal to the Workers Compensation Board and check for eligibility. For more information, check here.
What if your issues lie in other medical related fields? There are other forms and appeals you can make for help. Billing, treatment, and managed care disputes all have channels and timelines to follow in order to appeal them. In order to get the best advice and counsel, a lawyer may be needed.
Having a claim denied can be tough on you and your loved ones. If you don’t know where to turn or how to move forward after a denial, there are lawyers out there that can help. If you would like to receive a free consultation on your case, call us at 888-813-3188.
Requesting Reconsideration
When your claim is denied, you can petition your insurance provider or claims examiner to think twice about the decision. You do this through the Workers Compensation Division. Once your insurance sends a denial for compensation, you have 60 days to send in a request form to challenge the decision. Those forms can be found here.
Go to the Worker’s Compensation Board
If your insurance denies your reconsideration appeal, don’t fret. You can go the next step and consult the Worker’s Compensation Board for an appeal. Once they make a decision on your case, you can request a hearing. For instructions on how to do this, click here. You have a limited time to do this, so check the reconsideration denial letter or agency order you received.
Get Legal Assistance
If you are unsure how to proceed to get the best coverage, consider getting legal help from an attorney. When you appeal to the board, you will present a case, not just file paperwork. With this in mind, you’ll want a good lawyer by your side. Getting legal counsel can happen at any time during the claims process.
Other Options
There may be other circumstances that affect your claim and denial process. If so, there are still things you can do.
Temporary Disability Benefits
If you still can’t return to work even after a denied claim, you may qualify for temporary benefits. These apply under certain conditions, so it may be best to consult a lawyer to know what you qualify for.
Types of Temporary Disabilities
If you can’t return to work with modified duties due to your injury, you may qualify for Temporary Total Disability. If you can return with modified work, that falls under Temporary Partial Disability. To know what you best fit into, a lawyer may be needed. For more information, click here.
Independent Medical Exams
Sometimes, the dispute can be about your medical condition or injury that led to the workers’ compensation claim. If so, you can request to have a medical exam from a neutral source. When filing a claim, it often includes a mandatory medical exam, but not always. Your exam can impact your ability to receive coverage, so getting one is a crucial step.
Disputing Medical Exams
If your insurance denies your claim because of Independent Medical Exam results, you can still dispute this by taking a worker-requested exam. Your attending physician must agree to this as well. If so, you have 60 days to appeal to the Workers Compensation Board and check for eligibility. For more information, check here.
Other Medical Disputes
What if your issues lie in other medical related fields? There are other forms and appeals you can make for help. Billing, treatment, and managed care disputes all have channels and timelines to follow in order to appeal them. In order to get the best advice and counsel, a lawyer may be needed.
Contact Us
Having a claim denied can be tough on you and your loved ones. If you don’t know where to turn or how to move forward after a denial, there are lawyers out there that can help. If you would like to receive a free consultation on your case, call us at 888-813-3188.
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