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My Workers’ Compensation Claim Was Denied – What Do I Do?

Workers’ compensation exists to protect employees if they are unable to work due to a work-related injury, and employers from being sued for those injuries. Most work-related injuries and illnesses are covered by workers’ comp, but there are some exceptions. Further, even claims for covered injuries and illnesses may be denied due to application errors, untimely filing, or other issues. You may find the following information helpful if your workers’ compensation claim has been denied.

When a workers’ comp claim is denied, the claimant receives a letter informing him of the decision. One of the most common reasons for denial is untimely reporting or filling. When an injury or illness occurs, the law holds that the worker must report the claim right away, often within days. It is then the employer’s duty to immediately notify its workers’ comp carrier and the state. Failure to follow these steps precisely may result in a denial.

My Employer Disputed My Claim

This is another common reason for a denial. Let’s say you claim that your back injury is work-related, but your employer thinks you actually sustained your injury playing basketball. She might dispute the validity of your claim, which could result in a denial. If this occurs, you may need to gather additional evidence to substantiate your claim.

My Condition is Not Covered

Although most on-the-job injuries are covered by workers’ comp, there are some exceptions. If your injury is not serious enough to qualify, or the condition itself isn’t covered, your claim may be denied.

In MA, an injury that occurs outside of the scope of your job duties may not be covered. For example, if you and a co-worker decide to hit some golf balls in the field outside your office building, you aren’t likely to have a workers’ comp claim if you accidentally get hit in the head with a golf club. You may have been at work, during work hours, but hitting golf balls isn’t a work-related activity. The same would be true if you were inside the building at the time of your injury. On the other hand, if the same injury occurred at a golf course, during a work outing at which you were entertaining clients, you would likely be covered by workers’ comp.

Even if your injury or illness occurred on work property and in the scope of your job duties, the medical condition itself may not be covered. Some mental health conditions, such as stress, may not qualify you for benefits. A MA workers’ comp attorney can help you determine your eligibility for benefits.

Appeals Process

If your claim is denied, your first step should be to contact an attorney. The denial letter you received provides important information, including appeal deadlines. In some instances, the denial is a simple paperwork error, and the matter can be cleared up quickly and with relative ease. But this is rare. Generally, the first level of appeal will be with an administrative law judge, at which time you will need to provide additional evidence to support your claim. It is crucial that you file your appeal within the stated time limits, and that you have sufficient evidence to back up your claim.

Workers’ comp benefits are often denied the first time. That is one of the reasons why the help of an experienced attorney is so important. If you have been denied, the help of a Boston workers’ comp lawyer can make all the difference in the world. The appeals process is complex, and attempting to handle it on your own rarely results in a favorable outcome.

Altman & Altman, LLP – Boston’s Premier Workers’ Compensation Law Firm

If you have been injured in a work-related accident, the skilled legal team at Altman & Altman, LLP can help. We have been protecting the rights of MA workers for more than 50 years. It is our goal to get you the compensation you deserve in a timely manner, so that you can get on with your life. Contact Altman & Altman, LLP today for a free and confidential consultation about your case.

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