Thousands of Americans get hurt on the job every day. Injured workers face lost wages, health problems, and possibly even a legal fight. Workman's compensation insurance should pay for the medical bills for when you get hurt at work, but what happens if a claim is denied? An attorney is needed to give the guidance and direction for these cases.
What is Workman's Compensation?
Employers get workman's compensation insurance in case their employees get hurt while working. This is called "strict liability" insurance. This means that neither the worker nor the company is held at fault. If the employer has workman's compensation, the employee will get medical care right away and get any ongoing treatments they might need. The worker will not have to pay for the visits, therapies, or medicines that the insurance company's doctor or other medical professional prescribe. They have to follow the course of treatment carefully.
Why Would a Claim be Denied?
Workman's compensation has its share of denials like all insurance. There have been many cases of employees claiming injury or exaggerating their injuries to defraud the insurer, so these companies should be expected to act in their own interests. If someone lies or inflates their claim, it will be denied. Paperwork or billing issues can result in an "administrative" denial of a claim. Not filing the claim on time, having pre-existing conditions, not following medical advice, and not giving enough proof for the claim can also bring a denial verdict.
Can I Appeal?
Workman's compensation laws and procedures vary by the state and every state has a claim appeals process. If someone believes the insurer denied their claim unfairly, or because of invalid reasons, they need to appeal it right away. Contact an attorney who specializes in appeals in workman's compensation. Many states have very short time windows in which to file an appeal, so quick action is essential. Unless they act fast and pursue the case, nothing else can be done. The injured person would have to pay for everything. The injured person would have no other legal recourse, since using workman's compensation eliminates the option of suing the company for damages.
Appellate Process
The insurer will send a letter that will give the reasons for the denial. The injured person should contact their job's benefits department and reply to the letter quickly to begin the appeal process. Administrative problems can often be fixed easily. This is why it is so important to keep any paperwork you get from the job, insurer, or doctor. The claim will be denied again if the original reason for the denial is not dealt with. With an attorney's help, the claim can be appealed.
Why Having an Attorney is Important
An attorney is essential for workman's compensation denials. They have the legal experience to guide you through the steps for appealing claim. Some states require filing of certain forms. Some hold a medical review panel. Others have a hearing like a trial, where witnesses can talk and evidence is given. All of these are situations where legal advice and an attorney's guidance are needed. They can keep you from having to pay your own medical bills.
Workman's compensation insurance is not required by every state. Every state has its own laws when an employer uses the coverage. If you are injured while on the job, you need to document your injury and treatment. Follow all the procedures and advice given by the insurer and doctor. If the claim is denied, consult with an attorney to follow up and try to reverse the decision.
With over 20 years experience, Reno Personal Injury Attorney Steve Hess has been representing individuals in auto accident, slip and fall, personal injury, wrongful death, and motorcycle accident cases.
To see what else Steve is talking about, read Steve's Blog.
Source: http://ezinearticles.com/6333961
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