What happens after a workers' comp claim denial?

The rules of workers' compensation insurance seem easy enough. If you suffer an injury on the job, your employer's insurance covers your medical bills and lost wages. Fault is not an issue since workers' comp exists to prevent lawsuits from clogging up the courts every time a worker gets an injury on the job.

This insurance may have been what you were counting on when you filed a claim for workers' comp after your workplace accident. However, if you recently received a letter from the insurer explaining that they had denied your claim for coverage, you may be confused and even concerned about your future.

Why did the insurer deny your claim?

The first thing to know about your benefits denial is that it is not necessarily the end of the line. You can still file an appeal, but you have to do so before the deadline, which is different for every state. The appeals process also varies from state to state, so it may help you to reach out to an Illinois attorney for a better understanding of how the process works here.

Next, you will need to have a good idea of why the insurer denied your claim. Your letter should explain this, but the following are some of the most common reasons for a claim denial:

  • Your injury is not one that workers' compensation covers, such as job-related mental stress or injuries suffered in a car accident on the way to work.
  • You did not seek medical care for your injuries, or you failed to complete the program of treatment your doctor ordered.
  • Your employer informed the insurance adjuster that he or she had reason to dispute your claim, such as your injury occurred during horseplay or outside of work.
  • You were dealing with drug or alcohol impairment at the time of the accident.
  • You missed the deadline for reporting your injury to your employer.
  • Your employer did not file your claim in time.

If the insurer has cited any of these or others as reasons for denying your claim, you may be able to provide evidence that supports your side. With the help of an attorney, you may be able to build an effective case that will allow you to appeal the denial of your claim, collect the benefits you need to cover your medical bills, and potentially get back on your feet and back on the job.

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