What Happens If My Workers’ Compensation Claim Is Denied?

Experiencing an injury at work is stressful enough without the added anxiety of having your workers’ compensation claim denied. Workers’ compensation benefits are critical, providing financial assistance for medical expenses and lost wages while you recover. Unfortunately, claim denials occur frequently, leaving injured workers uncertain about their next steps.

If you’ve found yourself in this challenging situation, understanding your options and how an experienced Indianapolis workers’ compensation lawyer can assist you is essential to protect your rights and secure the benefits you deserve.

Common Reasons Workers’ Compensation Claims Are Denied

Before exploring your next steps after a denial, it’s crucial to understand why claims are commonly rejected. Claims may be denied for various reasons, including:

• Missed Deadlines: Indiana has specific reporting deadlines for workplace injuries. If you fail to report your injury promptly or miss filing deadlines, your claim may be denied.
• Insufficient Medical Evidence: A claim may be denied if there’s inadequate medical documentation linking your injury to your workplace accident.
• Disputes Over the Cause of Injury: Employers or insurers might argue that your injury didn’t occur at work or was unrelated to your job duties.
• Pre-Existing Conditions: Insurance companies often claim your injury resulted from a pre-existing condition rather than a workplace incident.
• Errors in Paperwork: Mistakes or incomplete information on your application can lead to denial.

Understanding these common denial reasons can help you avoid them initially or effectively address them during an appeal.

Steps to Take Immediately After a Denial

If your workers’ compensation claim has been denied, it’s crucial not to panic. Instead, promptly take the following steps:

Review the Letter

Carefully read the denial notice you received from the insurance company or employer. This letter will specify why your claim was denied, providing a clear starting point for addressing the issues raised.

Consult an Attorney

Engaging an experienced workers’ compensation lawyer early in the process significantly improves your chances of a successful appeal. A skilled attorney can help you understand your rights, identify errors or weaknesses in your initial claim, and prepare compelling evidence for your appeal.

File an Appeal Promptly

In Indiana, you must act quickly after receiving a denial. You typically have two years from the date of injury or from the last date you received compensation to file an appeal. Missing this deadline can jeopardize your ability to challenge the denial entirely.

The Workers’ Compensation Appeal Process in Indiana

Understanding the appeal process helps reduce uncertainty and prepares you for what lies ahead. Indiana’s appeal process generally includes the following steps:

Informal Resolution

Initially, your attorney might attempt an informal resolution directly with the insurance adjuster or your employer. This step may involve negotiating to clarify misunderstandings or provide additional documentation that supports your claim.

Formal Appeal

If informal negotiations do not result in a favorable outcome, your attorney will file a formal appeal with the Indiana Workers’ Compensation Board. This action initiates a hearing before a judge, where both sides present evidence supporting their positions.

Workers’ Compensation Hearing

During the hearing, an administrative law judge reviews evidence from both parties. Evidence may include medical records, expert testimony, eyewitness statements, and documentation of your injury’s impact on your life and work capabilities. Your attorney will meticulously prepare your case, emphasizing clear connections between your injury and your job duties.

Receiving the Judge’s Decision

After the hearing, the judge issues a written decision. If the decision is favorable, you’ll receive the benefits initially denied. If the outcome remains unfavorable, you still have options for further appeals, including bringing your case to the full Workers’ Compensation Board or even filing an appeal with the Indiana Court of Appeals.

Why You Should Work with an Indianapolis Social Security Disability Lawyer

Partnering with a knowledgeable workers’ compensation and disability attorney greatly enhances your likelihood of successfully appealing a denial. An attorney specializing in workers’ compensation cases has comprehensive knowledge of Indiana’s laws, understands the intricacies of the appeals process, and is skilled in building a strong, evidence-supported case.

Additionally, if your workplace injury results in a long-term disability preventing you from returning to work, an Indianapolis social security disability lawyer can guide you through the process of applying for Social Security Disability Insurance (SSDI) benefits. SSDI benefits provide crucial support when workplace injuries result in prolonged or permanent disability.

Contact Lee Cossell & Feagley, LLP

A workers’ compensation claim denial doesn’t have to be the final word. At Lee Cossell & Feagley, LLP, our experienced attorneys are dedicated to fighting for injured workers in Indianapolis and throughout Indiana. We understand the frustration and hardship that a denied claim can cause and are committed to helping you navigate the appeals process effectively.

If your workers’ compensation claim has been denied, don’t wait to get the professional help you deserve. Contact the dedicated team at Lee Cossell & Feagley today to schedule a consultation. Let us advocate fiercely on your behalf to secure the compensation you rightfully deserve.