Workers Compensation Claim Denied: What’s Next?

A trade-off between an employer and employee, worker’s compensation protects the rights of employees who are injured during the course of their employment. The compensation, depending on the nature and complexity of the case, varies, taking the form of wage replacement, medical benefits, or other forms of financial support.

Like a personal injury claim, however, a worker’s compensation claim can be denied. When a claim is denied, it simply means that the employer, or in most cases, the insurance company, believes that a person’s claim is not covered or eligible for compensation according to the law. Among the most common reasons for denial are the late filing of the claim, lack of witnesses, and discrepancy in medical records.


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Once a claimant receives a note stating the illegibility of his or her claim, the first step is to review the grounds for denial and learn the procedure for appeals, specifically the deadline and requirements for filing. And because some denied claims can be due to erroneous paperwork and processes, it is also essential for workers to talk directly to their employer or insurance company prior to filing an official complaint in any court.


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If the appeal is denied, the final step is for the employee to contact a lawyer specializing in worker’s compensation as soon as possible. An attorney will determine the best alternatives and solutions for a denied worker’s compensation claim.

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An overview of worker’s compensation

Every employee is protected by a set of rules that safeguards his or her physical and emotional well-being. This includes finding proper compensation when injured during the course of his or her work. Most commonly known as worker’s compensation, this program enacted by the government is a basic right that all employees – particularly those engaged in risky and highly dangerous jobs – have. It states the companies are legally responsible for the welfare of their employees and should something happen to them during the course of their work, employers are required by law to compensate workers properly. This usually is in the form of monetary or medical compensation. The law also has provisions to protect the welfare of the individual’s dependents, should the employee die due to his work.

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It must be noted that each state has their provisions, with federal statutes being limited to federal employees. However, there are still basic guidelines that are followed. The main consideration in a worker’s compensation claim is that the injury (or death) must have been directly caused by the occupation, with the full knowledge of the danger known to the employer. For example, a railroad employee suffers an injury caused by a faulty track, he or she is eligible under the Federal Employment Liability Act (FELA) to file a complaint against his or her employee. It must be proven, beyond reasonable doubt, that the employer was either negligent or intentionally involved in the accident.

Establishing legal responsibility is only the first step in a worker’s compensation claim. The attorney, victim, and company, now have to determine the type of compensation the employee will receive. This refers not only to the amount, but how long the payments will be made.

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Learn how to protect your rights in case of injury with the assistance of Sheeley Law, an expert in worker’s compensation. Follow this Google+ page for similar discussions.