What to Do if My Workers’ Compensation Payment is Declined?
Last updated Wednesday, May 4th, 2022
Workers’ compensation declined? Keep calm and contact Skaug Law! These kinds of setbacks aren’t all that uncommon. It’s unfortunate, but valid workers’ comp claims are frequently denied. There are options. When you have legal help, this road becomes a lot less bumpy.
Here’s your next steps:
Step 1. Read the Claim Denial Letter… Again. You may be excited or nervous and skim the contents of the reply. Take a breath. Reread the letter carefully. Look for the exact reason why your claim is being rejected. Could a simple oversight be to blame? If a document is missing or incomplete, solving this problem could be fairly easy.
Step 2. Consult a Workers’ Comp Attorney. This topic can get super complicated in minutes. An experienced Idaho lawyer can skillfully review your case. Get professional advice on the best way to proceed.
Step 3. Stick with it. If you’ve decided that the response is a definite denial, don’t throw in the towel. Maybe this isn’t the easy path you’d hoped for but don’t let that stop you from pursing your rightful benefits.
Step 4. File a Complaint. Challenge a denial by filing a complaint with the Idaho Industrial Commission. This action can kick things off legally. Mediation is also offered through this organization as a means of settling disputes.
What is the Most Common Cause for Workers’ Compensation?
The idea of a traditional workplace setting keeps shifting. Specific industries tend to have certain incidences. Jobsite injuries can change each year. So pinpointing the most widespread reason for these claims isn’t easy.
There are, however, a handful of causes that continue to be why this insurance is necessary. Jobsite accidents that commonly account for workers’ comp claims are listed below along with potential injuries.
- Getting Hit by Something. Items can fall on workers, sometimes from soaring heights. When machinery malfunctions, pieces can be sent flying every which way. Equipment can fail causing materials to sail into unsuspecting employees.
- Gashes and/or Lacerations
- Head Injuries
- Having Unfriendly Equipment Encounters. Body parts can get crushed with mechanical failures. Run-ins with large machines or objects can hurt. Bumping into the wrong section of equipment can literally land you in hot water.
- Cuts and/or Punctures
- Eye Injuries
- Pushing the Body Past Its Limits. Your body may pay the price if you push through the pain on the job. Schlepping heavy items without assistance or proper equipment can lead to injuries. Working past the level you feel comfortable just isn’t worth it.
- Back Injuries and/or Dislocated Discs
- Rotator Cuff Injuries
- Repeating the Same Task. Doing the same thing again and again can bring on pain. Such work over time can cause repetitive stress injuries.
- Carpal Tunnel Syndrome
- Rotator Cuff Degeneration
- Tendonitis and Tenosynovitis
- Trigger Finger
- Slipping, Tripping and Falling. Slips and trips can occur throughout the workplace. Anything from loose cords to a spill can cause a single-story fall. Multi-story falls can be off ladders, scaffolding and roofs.
- Head Trauma
- Neck Injuries
- Pulled Muscles
Liability for emergency medical assistance by medically trained persons.
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Three Reasons Why Your Workers’ Compensation Was Declined
There are many possible reasons why claims aren’t approved. The best way to figure all of this out is to get professional legal help. Our attorneys at Skaug Law can review your case for free. We can provide pointers on what could have happened and what your next moves should be.
Three typical reasons workers’ comp claims get denied include problems with:
- Dates. Deadlines aren’t guidelines; they’re pretty much set in stone. Claims filed outside statutes of limitations are usually rejected. Injuries also need to be reported to supervisors immediately in Idaho. Another issue could be how the filing date corresponds with your employment. If you’re no longer working at the same place, an insurer may deny this type of claim.
- Medical Care. If no first aid or medical treatment was performed for a jobsite injury, workers’ comp benefits may be denied. Find out more specific rules on this topic from the Idaho Industrial Commission.
- Nature of Injury. There could be a dispute that your pain is work-related. An employer may allege your injury didn’t occur while you were working or didn’t happen onsite. Employers may also argue the incident resulted from your misconduct.
How do I Reverse my Workers’ Compensation Denial?
While details vary on a case-by-case basis, these claims have one thing in common: legal representation. Working with a knowledgeable lawyer can give you the best shot at getting a decision overturned.
Our team at Skaug Law pulls out all the stops to get you your benefits. We step up research efforts. Additional documentation might be needed to prove your case. That’s okay. We’ll make sure your medical records, witness testimonies and injury timeline are all in check.
Did You Know? The Idaho Industrial Commission has been known to cover attorney fees for injured workers. That’s right! When you’ve experienced unreasonable denials of your benefits, you may be eligible for such an award.
How to Appeal my Denial Claim?
There are a few things to do when seeking an appeal.
- Find Out Why. Contact your employer’s insurer. Ask exactly why your claim is being denied. If you learn there’s more than a silly mistake, then you can move on to the next step.
- File an Appeal. This act may seem fairly straightforward. Don’t get duped. While the directions for launching an appeal may be written out, they aren’t always so easy to follow. This process can be complicated. Without legal experience, it can be hard to make sense of everything.
- Meet with a Reputable Workers’ Comp Lawyer. If your first attempt was unsuccessful, you want to come back with all guns blazing. Maybe you gave it your best shot, but it just didn’t work. Let a professional step in on your behalf. These benefits are too important to risk. Leave denial in the dust with Skaug Law.