Workers should not have to worry if they get injured on the job since there is an insurance policy in place specifically for providing compensation. However, things do not always go smoothly in practice. Claims often get denied by insurers for many different reasons. Perhaps the documents were not filed on time, leading to an automatic forfeiture or maybe other parts of the process were not done correctly. Sometimes, they simply do not believe the claims! It can be an uphill battle fighting these insurers, but just remember that a denial is not the end of the road. Here is what to do when the work comp insurer doesn’t believe you’re injured:
Ask for Clarification
Try to seek clarification about their decision. The letter of denial should contain helpful details that you can use when submitting an appeal. Find out what caused them to doubt your claims so that you can address these point-by-point. Maybe you were not able to provide enough proof to back up your story; maybe they suspect that the incident happened outside of the workplace premises; maybe they suspect that the problem comes from an unrelated pre-existing condition. Whatever the problem, you must pinpoint what it is to be able to plan your next steps carefully.
Provide Strong Evidence
Now that you know the issues that led to the denial, you can work towards countering them with strong evidence. Make it abundantly clear that the injury does exist. Give them documents that will prove this, including all your related medical records. Hopefully, you went immediately to a doctor after accident or injury. Get the results of the lab tests, including X-rays and other scans; provide pictures of the injury and the place where the accident occurred; gather witness testimonies, so that they can see other people are supporting your claim. If workers were present during the accident, then they can be a big boost!
Get Help from State Agencies
In case the insurer still does not believe your claims after all that work, it may be time to seek outside help. You can take your case to the relevant state agencies. They will hear the facts and determine the merits based on the evidence presented. States have insurance boards that monitor and supervise the insurance companies that operate locally. They can intervene in the matter on your behalf if they think that you truly deserve compensation for what happened. It may take a while, so you’ll need to be patient.
Hire a Work Comp Attorney
Another thing that you should consider is getting a Greenville workers comp attorney. You will need their expertise and experience to overturn an initial denial. With their help, you will have a higher chance of success.