Claims for workers’ compensation offer safety for workers who are hurt on the job. Workers are entitled to benefits that pay for medical expenses and make up for lost income when a claim is accepted.
However, some claims are turned down, which can often leave you confused about what to do next, but before jumping to the steps you should take after your compensation is denied, let’s just have a look at the possible reasons behind the denial.
What are some common reasons for your worker’s compensation can be denied?
Understanding behind the rejection of your workers’ compensation claim is important, as many denials stem from simple, correctable issues. However, some cases are more complex and may require significant legal intervention to resolve. If your claim has been rejected, the best course of action is to seek quality legal representation.
There are several common reasons why workers’ compensation claims are denied. One primary reason is incomplete, inaccurate, or late paperwork. Claims may be rejected if the required documents are not properly filled out or if your employer submits the paperwork late. Ensuring the accuracy and timeliness of your documentation is essential in avoiding unnecessary delays and denials. Another common reason for denial is if the injury occurred during a lunch break. Injuries that occur during non-working hours or lunch breaks are generally not considered for workers’ compensation.
Read more: How long do Workers’ Compensation Settlements Take?
Another reason for denial is receiving medical care from an unauthorised provider. Workers’ comp insurers usually require treatment from specific healthcare providers. If you go to an unapproved doctor, your claim could be denied, although emergency care is typically covered. Injuries caused by horseplay at work can also lead to denials, as insurance carriers may argue that the injury did not occur while you were performing your job duties.
If your employer disputes the circumstances of the accident, the insurance company may deny the claim, emphasizing the importance of consistent accounts from both you and your employer. Finally, claims related to pre-existing conditions may be rejected, with insurers often arguing that the injury is not work-related but linked to a prior condition. Understanding these reasons can help avoid claim rejections and improve the chances of a successful workers’ compensation appeal.
Here’s what you should do when your worker’s compensation claim is denied
File a case
To challenge the initial decision on your workers’ compensation benefits, start by filing a case.
Receive notification:
You will be notified once your application is filed and provide a case number.
Request a hearing:
Moving forward, file a declaration of readiness to proceed, which will set a date for a mandatory settlement conference with a judge.
Go to the hearing:
Attendance at the conference is required of the claims administrator, you, your attorney, and the claims administrator’s attorney. Should a settlement not be achieved, a trial will be necessary.
Trial:
Assemble all required paperwork and show up for the trial. After the trial, the judge will typically mail a written ruling 30 to 90 days later.
Request reconsideration:
You can submit a petition for reconsideration to further contest the judge’s decision if you and the claims administrator don’t agree with it.
United Legal Canberra is here to assist you with your workers’ compensation claim. For more information, call us at (02) 6295 2283 or email us at admin@unitedlegal.com.au. Scheduling an appointment takes just a few minutes.
