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How to deal with workers compensation disputes

Author: Shelby Warden
Published: Feb 19 2013

Worker's compensation laws are meant to protect employees in the case that they are injured on the job. Companies provide worker's comp insurance to help injured workers get back on their feet by covering medical bills, lost wages and other expenses related to a workplace injury. Unfortunately, some workers end up getting their claims denied or disputed. There are several reasons why this could occur, so it is important for every worker to know about these possibilities to avoid heartache in the future.

Reasons Worker's Compensation Claims may be Denied

A worker injured on the job should always receive worker's compensation benefits, but many avoidable scenarios can lead to disputes or outright denials.

Injury Occurred while not Working

Many workers' compensation claims are denied based on the fact that insurance companies believe that an injury occurred while not on the job. This type of denial can occur due to misunderstandings or outright bad faith. An injury must actually occur while in the process of performing job duties to be compensable, so this is a common reason for denial.

Not Medically Justified

Worker's compensation benefits are meant to get an employee to their maximum health improvement. In most cases, this means that benefits only continue until a person is cleared to go back to work. Unfortunately, when a worker has to visit a company approved physician, they are sometimes medically cleared long before they should be. This can lead to an unfair cessation of benefits.

Failing to give Notice of the Injury

The first thing that any employee should do after being injured on the job or realizing that they're facing an occupational disease is notify their employer. This begins the worker's compensation process. Failing to do so in a timely manner can lead to a denial. Timeframes vary by state, so it is always prudent to report an injury as soon as it is noticed.

What to do if Worker's Comp Claim is Denied

Unfortunately, there are several other reasons outside of the aforementioned that can lead to a worker's comp dispute or denial. Luckily, a denial isn't the end of the road for most workers. There are steps that can be taken after such a refusal that may lead a person to get the benefits that they deserved in the first place. One step that is optional but very important is hiring a lawyer to handle the compensation denial.

It is unlikely that most workers will have a working knowledge of worker's compensation laws in their area, so an attorney is usually vital in getting a person the recompense that they deserve. According to a Texas attorney that has taken action against some of the giants like Travelers Insurance workers compensation, an experienced attorney can deal with insurance companies directly for a better outcome and, when necessary, take a case to trial.

Another step to getting benefits after being denied is to file an appeal with the insurance company. This can be done by an individual or their lawyer. Often, these appeals will lead to the same results unless a person has new supporting evidence in their favor. This makes it imperative for an individual to collect evidence such as doctor's reports, test results, statements from witnesses to the accident, rehab progress reports and any other evidence that will show that benefits are deserved.

If an appeal is turned down, it is possible to take the insurance company to court. This will usually be done by requesting a hearing in an administrative court of law. The requirements of these filings will of course vary by state, so once again, it is a very good idea for a person to obtain a lawyer before taking this step. Since most attorneys work on contingencies in these types of cases, there is usually no fee expected unless the case ends positively for the injured worker.

Worker's compensation claims can often lead to tricky situations. There are numerous laws and rules involved, and unfortunately, most people aren't legally adept enough to handle unfair denials. Securing an attorney is likely the best recourse that a person has, but regardless, it is important that they appeal and fight the decision as much as is legally possible.

Legal researcher Shelby Warden contributes this article for the benefit of workers who have been denied benefits for their injuries. The attorneys at Doyle Raizner in Houston have successfully represented injured workers against Travelers Insurance workers compensation, which is the largest American insurance company by market value. Their workers' comp team has the experience needed to go up against any of the large, profit-driven insurance companies to help you recover financially from your injury.

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