It’s lunchtime on a Thursday.
You step into the break room, but slip on a wet spot on the floor, hitting your head in the process. Several coworkers witnessed the incident and came to your aid. However, the damage is done. You have a concussion and will miss some time from work.
You filed a report with HR and went to the hospital. But weeks later, you receive a letter telling you that your Workers’ Compensation claim has been denied.
If this has happened to you, you’re not alone. Situations like this are extremely common, and many employees in Minnetonka have felt the same sense of confusion and helplessness that accompanies a claim denial.
The good news is that a denial doesn’t mean you are out of options. Fields Injury Law regularly provides injured employees in Minnetonka with Workers’ Comp legal help.
Why Workers’ Compensation Claims Are Denied
Receiving a denial letter for a legitimate injury suffered at work can feel grossly unfair. But understanding why your claim was denied helps you build a stronger appeal.
In many cases, Workers’ Compensation claims are denied for technical reasons, not because your injury isn’t legitimate.
Most denials happen for one of these reasons:
Late Injury Reporting
One of the biggest red flags for insurance companies is delayed reporting of an injury. It may cause them to question whether the injury is legitimate or if it actually happened at work. The best practice is to report a work-related injury as soon as possible.
Insufficient Medical Evidence
It's one thing to be injured, but it's another thing entirely to be injured at work. Therefore, it is vital that your medical documentation clearly connects your injury to an incident at your job. Claims that fail to make this connection are often denied.
Administrative Errors
Sometimes the reason for a denial is simply missing or incomplete paperwork. Incorrectly filed forms and missed deadlines can cause a claim to be denied, even when the injury is legitimately connected to your workplace.
Disputed Work Injury
Insurers will sometimes argue that an injury isn’t as serious as claimed, or they may argue that there isn’t enough proof that it happened at work. The best way to avoid this is by reporting incidents as soon as possible after they happen and ensuring that your medical documentation links the injury to your workplace.
What Happens When a Workers’ Compensation Claim is Denied
Although it may feel that way, receiving a denial isn’t the end of the road. It’s simply the beginning of the Workers' Compensation appeal process.
Minnesota law gives injured workers the right to challenge a denial and pursue denied Workers' Comp benefits.
The process starts by filing a claim petition, which formally notifies the insurance company that their decision is being challenged. The injured worker and the insurer can then attempt to negotiate a settlement.
If it doesn’t get resolved early, the Workers' Comp hearing process comes next. The case proceeds to the Minnesota Office of Administrative Hearings, where a judge will hear evidence from both sides.
This can result either in an approval of benefits, a negotiated settlement, or continued litigation if the case isn’t resolved.
How a Minnetonka Workers Compensation Attorney Can Help
If your Workers' Comp claim is denied, an attorney can help you navidate the Workers' Comp appeal process. They can:
Investigate the Reason for Denial
Whether it's due to a lack of medical evidence, a disputed injury, or a simple administrative error, an attorney’s first matter of business is finding out the specific reason your Workers' Comp claim was denied.
Communicate With the Insurer
When a claim is denied due to a technical issue, like an incorrectly filed form, an attorney can often step in and communicate directly with the insurance company. Small issues like this can typically be resolved with a follow-up letter from your attorney.
File an Appeal and Build Your Case
For more complex issues, an attorney will formally file your claim petition and begin building your case. An attorney can gather additional medical evidence as well as eyewitness accounts of the injury that challenge the insurer’s reason for denial.
Negotiate a Settlement
A Workers' Compensation appeal attorney can initiate direct negotiations with the insurer and attempt to resolve the dispute with a settlement. Insurers may prefer to resolve a Workers' Compensation claim dispute through settlement, rather than going through the legal appeals process.
Represent You at a Hearing
If the case cannot be settled, an attorney can formally represent you throughout the Workers' Comp hearing process. Your attorney will present evidence for your case, question witnesses, and advocate for your benefits.
Do You Need a Workers’ Compensation Appeal Attorney?
While it is possible to challenge a denial on your own, a Workers' Compensation attorney can make a significant difference in the process.
Insurance companies handle these claims every day. They often have experienced teams handling these claims, which can give them the upper hand over injured workers without representation.
Having someone in your corner changes that dynamic.
Experienced attorneys have seen these cases play out countless times, and know what insurers tend to push back on. They’ll take care of the paperwork so that it's error free, and negotiate directly with your insurer and advocate for a settlement that maximizes the value of your benefits.
And if needed, they can legally represent you during any hearings and protect your rights.
Workers’ Comp Claim Denied? Get Legal Help From Fields Injury Law Today
Having your Workers' Comp claim denied can feel like a low blow when you’re recovering from an injury and worried about your future. But a denial doesn’t mean the end.
You have the opportunity to challenge the insurer’s decision, and Fields Injury Law can help you understand your options and build your appeal.
Contact Fields Injury Law today for a FREE initial case review. It costs nothing to get your questions answered today.
Fields Injury Law — Attorney responsible: Steve Fields
*DISCLAIMER*
This blog is for informational purposes only and does not constitute legal advice. Every case is unique and results may vary significantly. For personalized advice on your specific situation, consult with a qualified attorney.
