No matter where you work, despite each state having its own laws and processes for filing workers’ compensation claims, one thing is for sure. Insurance firms will try to explain the denial of claims by citing details such as precise standards and deadlines. In the majority of workers’ compensation cases, the initial claim denial is a disputed matter.
You must realise that insurers will act in their best interests, which may entail reducing settlements or rejecting claims altogether. They will look into claims to see if there is a way to lower settlements or withhold benefits.
This is the perfect opportunity to speak with personal injury attorneys in Philadelphia, PA, if you haven’t already done so because the insurance company will undoubtedly send legal counsel to support their position.
When refusing workers’ compensation claims, insurance companies frequently cite the following reasons:
- The worker neglected to let the employer know about the mishap and injury.
- The worker did not sustain any workplace harm.
- The employee failed to submit a workers’ compensation claim by the deadline.
- The employer contests the injury claim made by the employer.
- Under the influence of alcohol or drugs, the employee was in the situation that led to the injury.
- The worker’s wounds are not severe enough to require coverage.
- There is no workers’ compensation coverage for the employee’s medical condition.
- The employee was let go by the business or dismissed
Additionally, you should be aware that it is against the law for an employer to dismiss a worker for submitting a workers’ compensation claim or reporting an injury. If this holds true in your situation, your employer has broken both federal and state labour laws. Therefore, in addition to your workers’ compensation claim, you may want to think about bringing a third-party lawsuit against them.
When to Appeal a Rejected Workers’ Comp Insurance Claim
Finding out the insurer rejected your claim could annoy and frighten you. Fortunately, you have the option to contest the rejection and raise an appeal. The reason the insurer rejected your claim must be stated in the rejection letter, along with information on how and when to appeal the decision and a deadline notification. The risk of losing your eligibility for assistance if you miss this deadline makes it vital.
Consider speaking with a local workers’ compensation claim attorney for advice if you are unsure how to proceed with your claim or don’t completely comprehend the letter of denial’s contents.