x

What to Do if You’re Workers’ Compensation Claim is Denied

You shouldn’t give up on getting your workers’ compensation benefits if an insurance company denies your claim. Work comp claims can be denied for a variety of reasons, and you may still be entitled to benefits. At Fields Law Firm, our Minnesota workers’ compensation lawyers can help build a strong appeal on your behalf, so you have the best possible chance of getting your claim approved.

Let us answer your questions about the workers’ compensation appeals process. There’s no obligation to become a client, and the advice is free. Pick up the phone and call 1-888-343-5375 or complete a free contact request form for help with your claim. Calls are answered 24 hours a day, seven days a week.

Why was my Workers Compensation Claim Denied?

After you are hurt at work, you may be surprised to learn that the insurance company has denied your worker’s compensation claim. Many people assume that when they are hurt at work, their employer will cover their medical treatment and lost wages due to their work related injury. However, that is not always the case.

In general, Minnesota Workers Compensation law allows an injured worker’s employer and insurer the opportunity to investigate the claimed work injury and the circumstances surrounding the injury.

When an Insurer receives notice of a claim for worker’s compensation benefits, the Insurer conducts an investigation of the claimed work injury. In this investigation, the Insurer may review video of the workplace, gather information from co-workers and supervisors, review medical records and doctor’s notes, and speak to the injured worker.

Based on this investigation, the claim will then be accepted or denied. The Insurer for the Employer will make one of three different types of liability determinations. First, the claim may be accepted and the Insurer will pay for related medical treatment and wage loss benefits.

Second, the claim may be accepted and related medical treatment may be paid, but not wage loss benefits. Finally, the claim may be denied in its entirety; this is called a primary liability denial.

Medical Benefits Only

If you are injured at work, but do not miss any time from work due to your injury, the Insurer may tell you that your claim is accepted but wage loss benefits will not be paid.

In this situation, if your doctor or provider takes you off work due to your work injuries, make sure to provide a copy of the work restrictions to your Employer and Insurer so that the Insurer may review the decision not to provide wage loss benefits. Generally, if you miss more than three days from work due to your work injury, and have a note from your doctor that takes you off work for more than three days, wage loss benefits should be paid.

Primary Liability Denial

When primary liability is denied, that means no medical benefits or wage loss benefits will be provided to the worker by the Employer and Insurer.

In this situation, the Insurer commonly determines that the worker’s injury was not caused by work activities. Other reasons liability is denied by the Insurer include: the worker was not an employee when the injury occurred, the employer is exempted from providing workers compensation benefits by law (for example some family farms, as defined by Minnesota law, do not need to provide workers’ compensation benefits), there is no proof of the work injury, the injury did not arise out of/or in the course of employment, or the worker had the medical condition before the claimed work injury.

If you disagree with the Insurer’s liability determination, you should contact a Minnesota Workers Compensation attorney to discuss your rights and responsibilities under Minnesota workers’ compensation law. In certain situations, there may be a legal reason why a worker is not entitled to worker’s compensation benefits.

Commonly, after the Insurer has made a primary liability denial, the injured worker needs to file a formal Claim Petition with the Office of Administrative Hearings, Workers’ Compensation Division, to obtain benefits the worker is entitled to receive pursuant to law.

Minnesota Workers’ Compensation Appeals Lawyers

Just one error or omission on your workers’ compensation paperwork can cause your claim to be denied. Our workers’ compensation attorneys will request your Notice of Insurer’s Primary Liability Determination Form, which details the reasons why your insurer denied your claim.

Once we know why your claim was denied, we’ll do everything we can to help you get your benefits. Whether we need to gather additional medical evidence or hire an expert witness to dispute the insurance company’s ruling, we’ll help you through every step of your appeal. Insurance companies have teams of lawyers fighting for them – let us protect your rights to the benefits you need.

Legal Help You Can Trust

If you find your workers compensation claim denied, call Fields Law Firm. We can help you get the Workers Compensation Benefits you deserve. We know insurance companies can make it hard for you to get benefits, but you’re not alone. Our Minnesota law firm has one of the largest team of professionals dedicated to helping injured workers in the state, and we want to help you, too. Contact us anytime if you’ve been denied workers’ compensation benefits. We’re here to listen.

Tweet about this on TwitterShare on FacebookShare on Google+Share on LinkedIn