If you have been injured on the job, it can be frustrating if your workers’ compensation claim gets denied. But you do not have to give up in defeat. Find out what you should do to appeal the decision and continue your pursuit of benefits.
Our workers’ compensation attorneys at Greg Coleman discuss your next steps below. If you need assistance with your workers’ compensation claim, contact us today for a free, no obligation consultation.
Common Reasons for Denial
Workers’ compensation claims are initially denied for many reasons, which include:
Late Application/Notification of Your Employer
Workers’ compensation claims must be filed within a certain timeframe for you to be eligible for benefits. You must also notify your employer about your injury within a certain period of time.
In Tennessee, your accident must be reported to your supervisor within 15 calendar days from the date of your injury. Your supervisor will then complete all necessary forms to submit to the company’s workers’ compensation insurance provider.
If you fail to report your injury to your supervisor within the 15-day timeframe, your application is likely to be denied.
Your workers’ compensation application must also be filed within one year of the injury for you to be eligible for benefits.
Lack of Medical Records
Your medical records are key evidence that help show your injury was work-related. If you did not go to the doctor for treatment, you will not have the necessary supporting medical records to show your injury as well as its cause.
For an injury to be covered by workers’ compensation, it must have occurred at the workplace or while performing work-related duties. An employer may claim your injury was not work-related, or that the injury was a result of misconduct at work.
Witness testimony is valuable to your workers’ compensation claim, and helps you prove the injury took place at work. Without witness accounts, it may be difficult to prove, which can result in your claim’s denial.
Steps to Take When Your Application is Denied
If your workers’ compensation benefits get denied, there are several steps you can take to appeal the decision.
Contact Your Employer’s Insurance Company
Once your worker’s compensation claim has been denied, contact your employer’s workers’ compensation insurance company. Ask why your claim was denied.
Once you know why your claim was initially denied, you can decide if you wish to appeal the decision. If the issue behind the denial is relatively simple to correct, you may be able to submit the additional needed information and resolve the issue.
Hire an Attorney
If you wish to appeal your workers’ compensation benefits denial, it is in your best interest to hire a Knoxville workers’ compensation attorneys. With experience working through the claims and appeals process, your attorney provides invaluable guidance throughout each step and knows what evidence is needed to strengthen your claim or appeal.
File an Appeal
Once you have received a denial letter from the workers’ compensation insurer, you may begin appealing the decision. The first part of the process is called mediation, and it involves both parties attempting to resolve the situation. Tennessee’s Mediation and Ombudsman Services of Tennessee (MOST) program runs a three-part process for mediating disputes.
MOST will assign you a neutral third-party mediator to work on your case. The entire process should take no more than 20 days, in most cases.
However, if both sides are unable to reach an agreement, the mediator will give you a Dispute Certification Notice. This form will also be filed with the Clerk of the Court of Workers’ Compensation Claims.
You can request a hearing in the Court of Workers’ Compensation Claims, but you must do this within 60 days of the Dispute Certification Notice being issued. If the court decides to accept your request, a hearing will take place in 30 days.
You are required to take part in mediation once again. If this is unsuccessful, a judge for the Court of Workers’ Compensation can hold a hearing or simply review the evidence. The judge will eventually make a decision.
If you are still being denied benefits, you can appeal within 30 days of the judge’s order. A three-person Tennessee Workers’ Compensation Board panel reviews all evidence of your claim that has been submitted – you are not allowed to present new evidence at this stage.
Get in Touch with a Qualified Attorney Now
If your workers’ compensation claim has been denied, our will work to pursue the compensation you deserve. We will evaluate your workplace injury claim and inform you of the legal options that may be available to help you pursue maximum compensation.
Schedule a free, no obligation consultation with our legal team now. There are no upfront fees and you only pay us if we recover compensation for you.