Worker’s compensation claim denial is not an uncommon event. Even though most claims get paid by the employers or insurance company, some claims get denied. As per Charles Spinelli, even though you should not get heartbroken because of a claim denial, you should not sit back and wait for things to settle down. It is because things don’t get settled down on their own. You need to turn the wheel on motion and then everything will begin to change. However, before anything else, let’s see why worker’s compensation claims get denied.
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Charles Spinelli On Claim Denial
Workplace injuries or accidents sometimes turn into expensive endeavors. The sad thing is that despite placing safety measures in the workplace, accidents still occur. Employees also acquire illnesses due to workplace-related pressure or exposure to dangerous premises. Worker’s compensation law is complicated. It makes employees entitled to compensation for injury or illness acquired in workplaces. But it does not cover all the illnesses or injuries. Therefore, the first thing to do is – gather information about the denial process. When a worker's compensation claim gets denied?
- Failure to Report Promptly: One of the reasons why this claim gets denied is – delayed report. If you have been injured in the workplace, you should report the injury on the spot. Delaying can lead to claim rejection.
- Lack of Medical Evidence: Insufficient or conflicting medical evidence can lead to claim rejection as well. This is why, you must focus on evidence collection if you want to claim compensation for injury or illness.
- Pre-existing Conditions: In case, you have some pre-existing health condition that got amplified in the workplace, your claim may get rejected. This situation is so sensitive that you will need a lawyer to help you.
- Disputes over Causation: A medical report dispute is another issue that may lead to your claim rejection. If your medical report is opposed by the insurance company’s physician, you may face claim rejection.
- Failure to Follow Proper Procedures: As worker’s compensation claim is a legal process, everything needs to be proper. So, when you are submitting your claim, you must pay attention to details.
What to Do If Your Claim Gets Denied
Claim denial is heartbreaking. However, you don’t need to feel sad. Even if your claim has been denied, there are still ways to fix the problems.
- Review the Denial Letter: Carefully review the denial letter to understand the specific reasons for rejection.
- Seek Legal Counsel: Consider consulting with an experienced attorney specializing in worker’s compensation claims.
- Gather Additional Evidence: Identifying all the gaps will help you submit your appeal. Seek expert guidance in reviewing and reevaluating your previous claim.
As per Charles Spinelli, compensations usually don’t get denied. However, when you ignore the need to submit detailed compensation, you expose yourself to the chance of getting rejected. Any expert will tell you that the worker’s compensation claim process requires strict evidence collection. Without evidence, you will never be able to establish your eligibility. In addition, any legal process requires elaborate paperwork. You need to take care of documentation to secure your claim.
