What a Workers’ Compensation Denial Means

 In Blogs, Workers' Compensation

There are many reasons why your legitimate workers’ compensation claim was denied by either your employer or insurance company. This can be disheartening and debilitating to your bank account. In this post we explore the reasons why your claim might be denied and what you can do about it.

Your claim is delayed.

You know you need compensation as soon as possible to cover your medical bills and make up for lost income. What is the highest priority for you is on the back-burner for your employer. They may claim they need time to conduct an internal investigation or hire an outside party to make assessments. In this case, you are entitled to up to $10,000 in medical care compensation to cover your expenses. This letter should also give you a date by which you can expect your claim to be accepted or denied. If you received a letter that states that your claim is delayed, call us immediately. We can ensure you receive what is owed to you under state law.

They cite “red flags” as a reason for delay or denial.

Insurance companies operate on a system of rules that are rarely revealed outside of their company. Fortunately we have worked with various companies long enough to know what many of these are and can help you mitigate them. A few examples of red flags that might encourage the insurance company to delay or deny your claim include:

  • You come in on Monday claiming you were injured on Friday when no one else was around. Some insurance adjusters may view this as an opportunistic way to capitalize on an injury that actually occurred over the weekend. To combat this assumption, keep a detailed account and, if possible, secure witnesses.
  • Your claim is denied for no obvious or stated reason. If your claim is delayed, they should be able to tell you in very clear terms why that is so. To be proactive, try to imagine if anything in your statement could’ve given way to doubt.

You don’t have the best relationship with your employer.

It’s simply a fact of life that sometimes we don’t get along with our bosses as well as we would like. If you already had a tenuous relationship with your employer, they may be more inclined to do whatever they can to prevent their insurance company from paying you out. If this is the case, hire an attorney that specializes in workers’ compensation immediately. We know the specifics of these laws and will represent you more aggressively and effectively than you could yourself.

You can win presumed admittance.

If you have received a delay letter, your claim must be approved or denied within 90 days. If you do not receive a verdict within 90 days, you may be able to claim “presumed admittance.” This essentially means your employer could not disprove your claim in the allotted time. You may still need an experienced workers’ compensation attorney to help you recover the compensation to which you are entitled.

Hire a proficient attorney.

The Law Office of Michael L. Studd efficiently represents workers’ compensation claims for Pittsburgh residents. Call us today at (412) 400-6157 to review your case.

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