Reasons for Workers’ Compensation Claim Denials

Reasons for Workers’ Compensation Claim Denials 

Experiencing an injury on the job can be life-changing, and it is important for your workers’ compensation claims to be processed in a timely manner so you can get on with your life. Claim denials can be difficult to deal with or understand. This highlights the value of a workers’ compensation attorney like Matt Matthews, who can assist after a denial. There are a variety of reasons why your claim might be denied, and upon denial, you must follow the legal appeals process to continue the pursuit of your claim. 

Read on to learn why your workers’ compensation claim might be denied, and how an attorney can help. 

Main Reasons for Workers’ Compensation Denials

Insurance companies can find many reasons to try to deny a claim, including:

• A lack of sufficient evidence the injury was work-related
• Failing to follow a treatment plan 
• Missing work and medical treatment were unnecessary 
• Failing to properly report an injury and file a claim on time

Sometimes, you can address the reason for the denial, such as insufficient evidence, and they might reverse the denial. An attorney can identify how to best respond to the denial to increase your chances of being granted benefits. 

Appealing Your Denial 

Most states have an administrative process that involves appealing a claim denial with the state workers’ compensation board or department. However, Alabama is different, and there is no such internal process for appeals. Instead, you must file a lawsuit in state civil court to appeal the overall decision. 

If you only need to appeal a denial of certain medical benefits, you might appeal to the Ombudsman Program with the Alabama Department Labor so they can mediate the matter before you head into court. However, if the insurance company does not agree to mediation, this program cannot decide disputes over non-medical issues with your claim. 

Filing a lawsuit in civil court is a complicated process with many rules, laws, and procedures that apply. It is critical that you have the right legal assistance during this process. 

A Workers’ Compensation Attorney Can Help you Navigate the Process 

A delay or denial of your workers’ compensation benefits can seem like it puts your life on pause, and medical bills and treatment costs might still continue adding up while your claim processes. The appeals process is best supported through the assistance of an experienced and knowledgeable personal injury attorney with experience in workers’ compensation cases. 

The right attorney will know the steps to take following a denial, so you can continue focusing on your physical recovery and getting back to work. Never give up on the benefits you deserve - make sure you have the right legal help if your claim is denied. 

Reach Out to a Montgomery Workers’ Compensation Attorney About Your Claim Today 

If you are having difficulty processing your workers’ compensation claim or related denials, an experienced workers’ compensation attorney from the Law Office of Richard F. Matthews, Jr. is here to help. Visit our site to book a consultation on your case today.