Workers’ Comp Denied My Claim. Do I Still Have a Case?

Mar 25, 2022 | Workers' Compensation

If your workers’ compensation claim is denied, you might still have a case and be able to receive compensation for your time away from work and your medical bills. It just might mean that you need to hire a workers’ compensation attorney to prove your case to reverse the insurance company’s decision.

The commonwealth of Virginia has set forth a process for challenging a workers’ compensation claim denial. You’ll file a written request for a hearing with the Workers’ Compensation Commission and send it to 1000 DMV Drive, Richmond, Virginia 23220.

Here’s what you need to know about Virginia workers’ compensation law and what to do when a claim is denied.

Virginia Law for Covered Injuries Under Workers’ Compensation

Virginia law outlines three main requirements for an injury to qualify for workers’ compensation benefits.

  1. The injury must take place at work or during a work function
  2. The injury must have been caused by a work activity
  3. The injury must have happened suddenly or at a specific time (not an overuse injury, such as tennis elbow)

If your injury was caused by misconduct or you were acting outside the normal scope of your work, you will likely get a claim denial for your case.

You must provide your employer with written notice of the accident within 30 days from the date of the accident. Additionally, you have two years to file a claim with the Virginia Workers’ Compensation Commission. These two deadlines will be crucial to ensuring you get your benefit.

Your employer is also required to complete the First Report of Injury form, which triggers the Virginia Workers’ Compensation Commission to send you information about your rights and what’s expected of you during the filing process.

 

Common Reasons for Workers’ Compensation Claim Denials

Sometimes overcoming your workers’ compensation claim denial comes down to providing greater evidence in the case or adding missing information.

Here are some of the most common reasons for workers’ compensation claim denials:

  • The accident did not take place at work
  • Your employer is disputing the claim
  • You didn’t file the claim by the deadline
  • The claim you filed had discrepancies between your documented injuries and the accident report
  • The injuries you sustained were not severe enough for workers’ compensation coverage
  • You failed to seek medical care for your injuries
  • You received care from providers who were not on the certified list

 

You should get a letter from your employer or workers’ compensation insurance provider specifying why your claim was denied. Within that letter, you’ll find information about how to appeal the decision and how long you’ll have to complete the appeal process.

Benefits of Hiring a Workers’ Compensation Attorney

Failing to receive workers’ compensation benefits can have enormous impacts on your life and your family. Without your wages, you might have to use money from your savings account. And you will have to pay all medical bills out of pocket, which will further harm your financial status.

Hiring a workers’ compensation attorney can put you on the right track toward recovering physically and financially.

You’ll experience these great benefits when you hire a workers’ compensation attorney to help you through the process.

  • Review of your benefits and rights based on Virginia’s laws
  • Completing paperwork on your behalf or assisting with it to ensure the right information is present
  • Meeting filing deadlines
  • Working with medical providers to obtain documentation necessary for proving your injuries
  • Locating and preparing witnesses
  • Presenting your case at a hearing

 

If you’ve experienced a workplace injury, schedule a free consultation with our team of skilled attorneys. We’ll discuss your rights with you and help you avoid a claim denial. Or if your claim has already been denied, we can begin the appeal process right away to ensure we complete it within the given timeframe.

Geoff McDonald and Associates: 804-888-8888.

FREE CONSULTATION

No Fees Unless We Win





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