Injuries in the workplace are common. They may happen because of the physical process in which a job is done, or they may be caused by someone else on or off the clock. Workers’ compensation is supposed to compensate injured employees for medical bills. But what happens when workers’ comp is denied?
Medical expenses are never cheap, especially when they require hospitalization or ongoing treatment from specialists. Denying workers’ comp leaves you with two options: work and provide the money yourself, or stop working and provide your medical expenses through alternate means such as Medicaid. If you are left to pay your medical bills, much of that money is taken out of your paycheck. This can leave you and your family in a bad financial situation.
Here we will describe what happens after workers’ comp is denied and what steps you can take to avoid serious financial hardship.
1. File an Application for Adjustment of the Claim
Visit your state’s Workers’ Compensation Commission and apply for a claim adjustment. This is a petition that you file with your employer’s insurance company to dispute their ruling. You have three years from the date of injury to apply for the adjustment. If you don’t apply within this time frame, you will lose your right to appeal, and you cannot be compensated for medical bills.
2. Request a Hearing
The commission will assign a case number, and an arbitrator will be selected to hear the case. You will receive notice of the hearing date, a copy of your case file, and a statement explaining how you are to prepare your defense. There will also be an opportunity at the hearing for you to present evidence and request witnesses and other types of evidence that can help you win your case. The law requires that all parties appearing at a hearing be sworn in and give an oath that they will tell the truth. You can submit a Petition for Immediate Hearing before the hearing. This document explains why the commission should grant you a hearing right away. If you require emergency medical care, this petition will be given. If this is your situation, a workers’ compensation lawyer can help you fill out a plea for an immediate hearing.
3. File an Appeal
At the hearing, the arbitrator will decide whether your case is worth keeping open or not. The arbitrator may determine that you should be compensated or continue to work and provide medical bills through your alternate payment source. The arbitrator will have received written input from each party and will decide on what is fair and reasonable. If unsatisfied with the decision, you have the right to file a Petition for Review to appeal the ruling. You will have 30 days to file the application for review after the date of the decision that is being appealed. Three commissioners from the WCC will receive the appeal, examine the arbitrator’s findings, and issue a written decision. This written decision will serve as a final ruling of the commission on appeal and will be binding on your employer’s insurance company. The case then goes to the courts for any further appeals.
Which Bills Does Workers’ Comp Cover?
Workers’ compensation covers medical bills directly resulting from the injury in question. These bills include X-rays, surgeries, CAT scans, MRIs, Part B medical insurance premiums, physical therapy, occupational therapy, and more. Most workers’ compensation insurance companies cover 80% of the allowed amount after you have met your deductible. The rules vary substantially from state to state, so be sure and read your policy carefully.
Options After Workers’ Comp Denies Your Claim
If your workers’ comp insurance company denies your claim, some options are available to help you. Group health insurance providers can help you find an alternate source of funding. The group health insurance policy will cover the expenses like workers’ comp does. Since the payments are coming out of your pocket, you must pay them back. You can also apply for Medicaid or Medicare, but this is not an easy process. You will need to provide medical records to prove that you are disabled. You must also prove that you cannot work due to your injury.
How An Attorney Can Help
An attorney can help guide you through filing an application for a claim adjustment, requesting a hearing, and appealing a decision. They will help you prepare all the documents and arguments in your favor. Insurance adjusters have many tricks to keep you from receiving workers’ comp benefits. They will often concoct claims beyond the rules and deny a legitimate claim. An attorney can give you advice on how to talk to them. They will guide you on what to say and what not to say. Their experience with workers’ comp cases will show them the best strategies. They will help you take action and make sure that you are treated fairly.
How To Choose a Workers’ Compensation Attorney in Your Area
Injured workers often have a difficult time finding the right workers’ compensation attorney in their area. Ask for recommendations from friends and family members. You can also search online for a listing of attorneys in your area by specialty. Look at their websites and read reviews to find someone well-known for their ability to win workers’ compensation cases. The state bar association is also a good resource for finding a lawyer in your area. It lists the names of attorneys and makes available information about the bar. They also keep their records online. You can use this to find someone who has been practicing for several years and is well-respected by judges and other lawyers in your area. At WIN Injury Network, our attorneys are dedicated to helping injured workers get the compensation they deserve. Our firm has a proven track record of success and has won hundreds of thousands of dollars for our clients. Contact us today for a free consultation with a lawyer, or fill out our online contact form to get help.
A workers’ compensation case can quickly become an emotional roller coaster. If you are injured on the job, you will want to ensure that you have a great workers’ compensation attorney. The longer you wait to file, the harder it will be to prove your case and get the money you deserve. If your workers’ comp claim was denied, talk to WIN Injury Network today. Do not let your injuries prevent you from planting a garden, fishing, or going outside to enjoy nature. We can help you get the medical care you deserve and the compensation that gives you the financial freedom to do what makes you happy.