Kalamarides & Lambert

What to do if your workers' compensation claim is rejected

Alaska workers who file a claim for workers' compensation often count on the benefits to help them through the costs resulting from medical treatment or having to take time off from work. When the employer's insurance company denies a claim, it can be hard not to feel hopeless.

Fortunately, many workers whose claim is initially controverted have the option of going further to pursue their claim. Your attorney can provide individual guidance as to whether continuing to fight makes sense in your situation.

Common reasons insurers controvert claims

Insurance companies may deny, or controvert, your claim for a number of reasons. You may belong to a class of workers who are not eligible for workers' compensation. Unless you argue the insurer incorrectly classified you as such a worker, you may not have recourse for this type of denial. Ineligible workers include officers of nonprofit organizations, part-time workers, temporary workers, sole or 50-50 business owners or taxi drivers who are contract workers.

In most other cases, denials happen because the insurer disputes some part of your medical assessment or the circumstances of the injury. Insurers may argue your injury did not relate to your work, not all of your treatments are medically necessary or your disability rating is not accurate.

Filing your appeal on time

The first step in the appeals process is filing the necessary form with the Alaska Workers' Compensation Board. Keep a sharp eye on the timeline and do not delay. Your deadline for this appeal is two years from the date of injury or from the date you received your last workers' comp benefit payment.

Investigation and hearing

Once you file your appeal, the insurer will need to file a response within three weeks. There will then ensue a period of information gathering by all parties. This typically includes getting a medical examination and expert opinions. The insurance company will also want to interview you. As the goal of such a conversation would be to look for weaknesses in your case, it is important to prepare with the help of an experienced attorney. The Board will then hold a hearing and issue its decision.

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Kalamarides & Lambert

Kalamarides & Lambert
750 W 2nd Ave Suite 200
Anchorage, AK 99501

Phone: 907-205-4997
Phone: 907-276-2135
Fax: 907-278-8514
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