Loading...

Fight Your Workers Comp Claim Denial with These Tips

Fight Your Workers Comp Claim Denial with These Tips

Every state in America requires the protection of workers from incurring debts due to injuries and illnesses contracted in the course of their employment.

This protection is the reason for the existence of various workers compensation laws. However, while the law seeks to provide benefits to sick and injured employees, it also mandates strict compliance with the eligibility and procedural requirements.

In Utah, at least 28% of compensation claims were denied by the U.S Department of Labor.If you also have been denied from acquiring the benefits of workers compensation, here are several possible reasons why it happened and what you can do about it.

Late application

Two possible situations bound a denial of a claim due to a late application: first is the delayed reporting of the injury to the employer, and second is the late filing of the petition to the insurance company.

In Utah, injured employees are given 180 days to notify their employer of the injury sustained when they were done as part of regular duties. The starting point for the existence of the right to demand workers compensation is from the date the injury was acquired.

As such, it is essential that after you have received the necessary treatment, you directly inform your employer.Once you have duly notified your employer, they must then file the necessary Employer’s Report and forward a copy to you and the insurance company within seven days. The first step is vital because the delayed report is imputable to you, while the second step is solely on the employer’s fault. Nonetheless, while a late application may still be entertained, it must be for a valid reason.

Failure to explain

One cannot just claim that he was injured because of his work. He or she must also be able to tell how the injury came to be. For such reasons, medical reports are always the first documents that must be forwarded to prove the existence of the injury and how it was sustained.

Pre-existing injury

One of the essential requisites for a worker to claim compensation benefits is that the injury or illness must have been acquired when he was doing his work. Any conditions that have existed prior to the injury will cause the automatic denial of the benefits to claim.

Contributory negligence

One of the most common reasons for the denial of a claim is contributory negligence, which is premised on the fact that the employee was negligent and is responsible for sustaining the injury. However, it is the employer’s duty to show proof that the employee was negligent because the laws provide for the presumption of compensation afforded to the employee.

How to Appeal the Denial of a Workers Compensation Claim

Having your claim denied does not mean that there is no chance for you to be compensated. Here are the following steps that you must undertake to move forward with your compensation claim.

1. Contact your insurer

Before you file an appeal, contact your insurer first to find out the reason for the denial of such a claim. If the rejection is based on missing documents or late applications, you can always try to convince your insurer to overlook or reconsider such error since what is in line are benefits that could greatly help you and your family.

2. Suggest a settlement

If you do not want to undergo an appeal proceeding, you can always ask for a settlement. More often than not, an employer would also prefer to settle to avoid expensive litigation. Such intention to an agreement can be done by notifying the commissioner so that the department can then hold a claims resolution conference. The following are the two forms of the settlement agreement:

Compromise settlement

A compromise settlement is basically when the insurance company agrees to compensate for the current and previous expenses incurred by the claimant. By agreeing to such an arrangement, the employee is waiving all his rights from claiming compensation for future costs. In short, only a portion of the benefits is ensured.

Commutation agreement

On the other hand, a commutation agreement is where the three parties (claimant, insurer, and the judge) agree on an exact amount or an estimate intended to compensate for future medical expenses.

The agreement means that only those costs incurred after the date of understanding will be reimbursed. When there is an agreement between you and the employer, make sure that such is placed into a written document so that all claims can then be dismissed upon the approval of the Utah Labor Commission.

3. File an appeal

However, if both parties are dissatisfied with the settlement, then you should file an appeal. In Utah, an appeal may be filed by the injured worker or his/her survivors, as the case may be, on the Labor Commission of the State of Utah. These are the following forms that must be submitted to start your appeal:

  • Application for Hearing
  • Medical Treatment Provider List
  • Authorization to Disclose, Release and Use Protected Health Information
  • Summary of Medical Records form or copies of medical records supporting the claim

4. Gather additional evidence

Now that you know that your previous evidence is insufficient to establish a claim make sure that you can gather other evidence. The appeal process is very similar to undergoing a trial, which is why it is essential to obtain evidence that will bolster your case. 

Contact a Reliable Workers Compensation Attorney

What lies between an appeal for a denial of compensation claim is the opportunity to enjoy the benefits that you deserve.

For this reason, having the right kind of help is necessary so that you can obtain these benefits. For the past 20 years, Davis & Sanchez has helped hundreds of families claim their well-deserved benefits. The firm specializes only in workers compensation cases, which assures you of their expertise and capabilities.

To get a free case evaluation and to know more about Davis & Sanchez, contact the firm at (801) 746-0290 or (208) 258-7000, or you could also visit them at 655 E 4500 S #120 Murray, UT 84107 or 4696 W Overland Road, Suite 162 Boise, ID 83705.

About Hal Davis

Hey I'm Hal, the founder of Davis & Sanchez. If you're looking for a workers compensation attorney in Utah, or a workers compensation law firm in Idaho you've come to the right place! Also, if you enjoyed this content please subscribe below for more.

Do You Have a Winning Workers Compensation Case?

Not sure if you actually have a case? No problem. Download our free PDF and find out if you have a solid workers comp case. The PDF is 100% free and will be immediately sent to your email inbox.