Receiving notification from your employer that your workers' compensation claim is being delayed or denied may be shocking, but it is not uncommon. Claims administrators are known to try and find some basis for a denial, especially when the consequences of the injury are expensive. They may try and claim that the injury was not job related or in some cases that you were not even an employee. This is not the end of your claim. Contact a qualified Missouri workers compensation attorney to help you challenge their refusal to validate your claim.
Getting the Compensation You Deserve
When you move forward and challenge a decision made by a claims adjuster it is begins with filing an Application for Adjudication of Claim. Your position as an employee is now referred to as applicant. This can be done yourself, but it is a legal process that demands a certain amount of knowledge of the law. It is better if you retain the services of an experienced attorney to help see you through the process.
A delay letter usually comes with a reason and asks for additional information before coverage will be continued. Sometimes this is a form letter sent out by the insurance company in an attempt to buy them some more time to investigate your claim further. You are entitled to a certain amount of medical care while your case is being investigated, but this will end if the claim is ultimately denied.
Insurance companies will come up with any number of invalid reasons to deny your claim. If the accident occurred off of the worksite they may try and use this as a basis of denial. Keep in mind, that injuries are covered by workers' compensation no matter where the accident occurred, so long as you were acting in the scope of your employment at the time of the incident.
The most common reason for denial is when a pre-existing condition is aggravated. Most insurance companies will fight these types of claims aggressively in hopes that they will be able to pay less of a benefit. Fortunately for employees, the law protects them and will still allow medical treatment for an old injury if it results from a new one that occurs at a work.
Workers Compensation Attorneys
The good news for an injured employee whose claim is initially denied is that if the decision is reversed they are usually granted interest on the monies that were initially denied. This happens often as in the case of a Missouri worker whose initial compensation claim was completely denied. After the decision was overturned and she was awarded a full payout of $265,000 the employer was also ordered to pay a 9% interest in addition to the benefits.
Workers' compensation is an insurance that is set up to protect both employees and their employers. It is a shame that some insurers will go through such lengths to deny a legitimate claim. Don’t let the initial denial deter you from seeking your rightful compensation. Contact an attorney at the Law Office of James M. Hoffmann to help you appeal that decision.
Call (314) 361-4300 to schedule a free and private consultation.
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