A worker injured on the job deserves benefits, including medical care. Sadly, too many Louisiana workers see their workers’ compensation claims denied, and they are left to pick up the pieces on their own. The good news is that you may have the right to appeal—but you will need to act fast.
Call Inzina Law Injury Lawyers today to find out how to appeal a denied workers comp claim. We can handle your appeal from start to finish and fight for the necessary benefits, but you should call us soon. There are critical deadlines to meet, and any appeal requires considerable work. We need time to canvass what happened fully and learn more about your medical prognosis. In this article, a Lafayette workers’ compensation lawyer discusses the appeal process in greater depth.
Reasons Why Workers’ Comp Claims Are Denied
Many Louisiana employers are required to have a workers’ compensation insurance policy, which pays benefits to workers injured on the job. Our clients often suffer major injuries in falls or other traumatic incidents, but they may also be covered if they suffer an occupational illness or repetitive stress injury.
Insurance companies do not approve every claim for benefits. Instead, they might deny the claim for one of the following reasons:
- Your injury was not work-related. Workers’ comp only covers work-related injuries. You might have suffered an injury at home or while on vacation. Those injuries are not covered.
- Your injury is pre-existing. Workers can receive benefits if job duties make a pre-existing injury worse. However, your claim will be denied if there is no deterioration of your injury.
- You failed to report the accident in time. Workers should file an injury report within 30 days of discovering they were injured. Typically, the clock begins the day you suffered an injury in a fire, electrocution, or fall. However, if you are diagnosed with an occupational illness, you should report it within 30 days of diagnosis. Failure to report in a timely manner suggests your injury is not serious.
- Your employer failed to let their insurer know. Employers must file a First Report with their insurer within 10 days. The insurer might delay or deny your claim if your employer misses this deadline.
- You tested positive for drugs. Workers’ compensation benefits are no-fault, but you aren’t covered if your injury stemmed from intoxication or drug use. Workers are usually screened for drugs when first treated. You can also be denied benefits if you refuse to submit to a required test.
- You can return to work. You might be denied benefits if your injuries aren’t so serious that you can’t work.
These are the most common reasons our clients are denied benefits. You should quickly call our office to discuss appealing a denied workers’ comp claim.
What Happens if Your Workers’ Comp Claim is Denied?
Workers have a right to appeal. You will need to file a form with the Louisiana Office of Workers’ Compensation Administration (OWCA) to dispute a claim.
There are deadlines you must meet. Your denial letter should spell out the process and deadlines.
Generally, you get one year from the date of your injury to file for appeal.
You will need to provide a copy of the appeal to your employer and their insurer, which is a reason not to delay.
There are certain steps in the typical appeal:
- Evidence collection in support of your claim. You need to address the reason why your claim was rejected. For example, the insurer might claim you were hurt outside work. You need evidence, such as witness statements, that establish you were hurt on the job.
- Mediation. The OWCA will schedule a mandatory mediation conference. Your attorney can attend with you. The purpose of mediation is to identify disagreements and see if both sides can reach an agreement. Although your participation is mandatory, you are not obligated to accept any recommendation from the mediator.
- Hearing before a judge. When mediation fails, the next step is to present evidence to a judge, who will decide whether you qualify for benefits. Many people win workers’ compensation cases at the hearing stage. Your attorney can present medical reports, expert testimony, and other evidence.
- Additional appeals. The hearing is not the end of the road. If you are unhappy with the result of the hearing, you can appeal to the Louisiana Court of Appeal. You have only 30 days to file a Notice of Appeal. Complicated or novel workers’ compensation cases might end up before the Louisiana Supreme Court.
What is Your First Step after a Denial?
You should immediately contact an experienced attorney. They can explain in more detail what happens if your workers’ comp claim is denied. We can also file your Disputed Claim for Compensation correctly and before any deadline, protecting your rights in the process. You don’t want to delay.
Many workers are upset when they receive a denial notice. They are injured, in pain, and need benefits. They are shocked to receive notice that their injury is considered unserious.
However, it’s critical to build an appeal the right way. It’s not sufficient to simply say you don’t think you should have been denied. We need to prove that the denial was unfair or contrary to the facts.
Suppose an insurance company says you are not seriously injured. You can certainly testify at the hearing. But it’s useful to have even more evidence, including a doctor’s report or testimony, as well as medical records. Our firm finds the evidence to use when bringing a claim.
Let us review. Workers’ compensation law is always changing, and we stay on top of all developments. Because deadlines are so critical to meet, we encourage you to reach out today.
Speak with an Experienced Lawyer for Free!
Appealing a denied workers’ comp claim requires experienced legal assistance. You do not have to go through this process alone. Instead, please reach out to Inzina Law Injury Attorneys. We have helped workers injured in all sorts of industries, including the maritime industry. Our firm is always eager to help injured workers get the compensation and other benefits they deserve.