You work hard for the good of yourself, your family and your employer. Unfortunately, something recently happened that you did not expect — you suffered injuries on the job. You, like many Alaska residents, have worker’s compensation benefits available to you. So, you filed a claim, fully expecting to receive the medical and financial assistance you require. However, your expectations versus reality turned out very different. Insurance rejected your claim, and this has left you wondering how you are going to cover your losses on your own.
Thankfully, the denial of a workers’ comp claim is not the end of the road. With a little help, you may still access your benefits. Before getting into how that may be possible, let’s go over some of the common grounds for claim denial.
Why was your claim unsuccessful?
Workers’ compensation claims are rejected for a myriad of reasons. Some of them include:
- The applicant fails to file the claim by the required deadline.
- The worker fails to report the injury to his or her employer in the specified time frame.
- Medical treatment is deemed unnecessary.
- The injury was not work-related.
- One’s employer denies the claim.
- The injury is not legally compensable.
If your insurance provider rejects your claim, the denial letter sent to you should explain why.
What you can do about claim denial
If you get word that your claim failed to receive approval, you have every right to appeal that decision. To do this, you must file your appeal soon after receiving your denial letter.
To appeal, you’ll need to file documentation about your claim and why you feel it was wrongfully denied. You may have to attend in-person hearings to present your case. If you do this, you do not have to do it alone. Legal counsel can put together your appeals documentation and be at your side during any required hearings.
Does the appeals process always have positive outcomes?
Sadly, no. Every case is different, and it is impossible to guarantee it will work for you. Still, in most cases, it is worth pursuing.
The purpose of workers’ compensation benefits is to protect employees and their employers when workplace injuries occur. Unfortunately, it seems that fewer people are getting the coverage they need when they need it most due to claim denials. You may not have to accept the rejection of your claim. Legal counsel can review the details of your case and assist you in filing an appeal if appropriate.
