Got a workers’ comp claim denied?
You’re not alone. Denied claims occur much more frequently than most injured workers understand, and the insurance company is not going to wave a magic wand to fix it for you.
Here’s the thing…
Get your denied workers comp claim approved. When you have the right attorney on your side you can:
- Challenge the insurer’s decision
- Gather the evidence that actually moves the needle
- Win the benefits you are rightfully owed
Here is how the process works from start to finish…
What’s Inside This Guide:
- Why Workers’ Comp Claims Get Denied
- What A Workers Comp Lawyer Actually Does
- The Appeal Process Step-By-Step
- Mistakes To Avoid After A Denial
Why Workers’ Comp Claims Get Denied
It’s useful to understand why insurance carriers say “no” before trying to turn that around.
Denials usually come down to just a few reasons. Insurance companies aren’t always right — they only want an excuse to not pay you. This is why having a workers comp lawyer like Tim Bartell can change the game for injured workers fighting for their lost wages, medical expenses and rehab costs.
Common reasons for denial include:
- Missed reporting deadlines
- Lack of medical evidence
- Disputes about whether the injury was work-related
- Claims of pre-existing conditions
- Paperwork errors and missing information
Did you know that by some estimates approximately 13% of workers comp claims are denied the first time they are filed. Wait…there’s more…..
In other states the percentages are much higher. Georgia has reported denial rates as high as 40%. Florida’s ranges from 10% to 25% based on different factors. That means a lot of workers are getting injured, then denied, and then told to fight for what they were originally owed.
The good news?
Denials are not final. An experienced workers comp attorney can investigate and reverse them quickly.
(Sounded easy enough, huh? Well…it really is, with the right guy backing you.)
What A Workers Comp Lawyer Actually Does
A workers comp lawyer does much more than paperwork. They handle every aspect of your case so you can concentrate on recovery.
Here is what a strong attorney brings to the table after a denial.
Reviewing The Denial Letter
Start with the denial letter. All insurance companies will send you one. It should list the specific reasons your claim was denied.
A workers comp attorney reads “between the lines.” They recognize faulty arguments. They identify holes in the insurer’s logic and determine precisely what evidence is required to reverse the decision.
Building A Stronger Medical Case
Most denials come down to medical evidence — or the lack of it.
A workers comp lawyer will arrange for appropriate doctors, secure proper medical opinions and ensure your injury is documented appropriately. This often means obtaining an independent medical exam by a specialist who the insurance company can’t bully.
Negotiating With The Insurer
Insurance adjusters are not your friends. They are taught from day 1 to low ball and pay out as little as possible. A workers comp lawyer is familiar with their playbook and will play it back at them.
Why does this matter so much?
Employees who hire an attorney always receive larger settlements. According to Lockton’s benchmarking stats, denied litigated claims averaged $36,991 in net pay, while non-litigated claims averaged only $7,489. Huge difference.
The Appeal Process Step-By-Step
After the lawyer accepts your case, then the appeal gets underway. Procedures vary from state to state, but generally it goes like this:
Step 1: File The Appeal
There is often a very tight deadline to file an appeal — typically between 30 and 90 days from the date of denial. If you miss it, the case is lost. A workers comp attorney will ensure every form is filed properly and on time.
Step 2: Gather Evidence
This is where the heavy lifting happens. The lawyer will collect:
- Medical records and doctor’s reports
- Witness statements from coworkers
- Accident reports and incident documentation
- Wage and employment records
The more evidence you have, the more difficult it becomes for the insurer to continue denying your claim.
Step 3: Attend The Hearing
Most workers comp appeals are heard at an administrative hearing before a judge. This isn’t your typical courtroom. It’s a workers compensation board or commission. The attorney presents the case, cross examines witnesses and makes arguments as to why the denial was incorrect.
Step 4: Negotiate Or Litigate
Most cases settle before the hearing is over. Some go beyond that. Either way, when you have a seasoned workers comp lawyer, you have someone who knows when to push and when to settle.
Statistics support this as well. Approximately 67% of claims that are initially denied end up being awarded within a year of filing. That statistic says it all about overturning a denial when done correctly.
Mistakes To Avoid After A Denial
Retaining a workers comp attorney is step one. However, there are still many things you should not do yourself that can sabotage your claim.
Steer clear of these common mistakes:
- Speaking with the insurance adjuster without consulting an attorney — anything you say can be misconstrued and used against your claim
- Missing medical appointments — this tells the insurer the injury isn’t real
- Going back to work too early — hurts your case and your recovery
- Posting on social media — insurers love to scroll profiles for “proof” you are fine
- Settling too quickly — a fast settlement is almost always a low settlement
Your lawyer will advise you on all of the above. However knowing what NOT to do will make their job much easier and the end result much better.
Final Thoughts
When a workers comp claim gets denied, it’s often just the start of the battle. With an experienced workers comp attorney on your side, your chances of reversing that denial and getting the compensation you deserve increase exponentially.
To quickly recap:
- Most denials are reversible with the right legal help
- A workers comp lawyer handles the paperwork, evidence and negotiation
- The appeal process has strict deadlines so move fast
- Avoid common mistakes that can sink the case
99% of injured workers who receive full benefits are those who are represented by an attorney. Don’t gamble with the insurance company. Get an advocate on your side.
Having your claim denied is discouraging. However, denials can be overturned — and with the right workers comp attorney at the helm, it can lead to an even better result.
