What to Do if Your Workers’ Compensation Claim is Denied

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.

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Minnesota Workers’ Compensation Appeal Process

If you have been denied Workers’ Compensation insurance benefits in Minnesota, you have the right to file an appeal with the Minnesota Department of Labor & Industry. It’s important to have an experienced Workers’ Compensation attorney at your side to ensure the best possible outcome in your case. Your case may include the following steps:

1. Your claim petition is filed.
Our team will help you complete your Workers’ Compensation paperwork and gather the
medical records you need to file a strong claim.

2. Your deposition is scheduled.
Similar to a recorded statement or interview, your deposition is a chance for your insurer to ask
you questions about your claim. If you decide to get help from a Workers’ Compensation
attorney, he or she will be present at the deposition with you.

3. Your insurer schedules an independent medical examination.
An Independent Medical Exam (IME) is a doctor’s appointment with a physician chosen by the
insurance company and employer. In cases where the IME concludes that your injuries are less
severe than they actually are, our legal team can help protect your rights to make sure you
have the best possible chance of getting your benefits.

4. Your case is settled.
After your deposition and IME are complete, your attorney will try to settle your case for a
lump sum payment with your insurer. If we are unable to reach an agreement with the
insurance company, we will schedule a hearing in front of a judge.

5. You attend a Workers’ Compensation hearing in court.
Our Minnesota Workers’ Compensation attorneys will present evidence and witness testimony
in front of a judge that may help prove the severity of your injuries. At the conclusion of the
hearing, the judge will issue a decision in the case ordering some or all of your benefits to be
paid or dismissing your claim.

6. You appeal your hearing denial.
You can appeal the results of your hearing within 30 days of the Workers’ Compensation
judge’s decision. Our Workers’ Compensation team will work hard to prepare a strong appeal
on your behalf.

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 Workers’ 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 Workers’ 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 Workers’ Compensation benefits.

Commonly, after the Insurer has made a primary liability denial, the injured worker needs to file a formal Claim Petition and request a Workers’ Compensation Hearing to obtain benefits the worker is entitled to receive pursuant to law.

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.