In the event you are injured in the workplace, you can file for workers' compensation benefits. However, there is no guarantee that your employer's insurance company will agree that you are entitled to benefits. If the insurance company has denied your claim, it is important that you understand why. Here are some of the most common reasons and what your attorney can do to appeal the decision.
Independent Medical Examination Report Challenges Your Injuries
In some cases, the claimant is required to undergo an independent medical examination, or IME. The IME is conducted by a doctor who is usually chosen by the insurance company. Ideally, the doctor is unbiased and fairly assesses your injuries. Unfortunately, this does not always happen. If the insurance company is refusing to pay because the IME report challenges the severity of your injuries, your attorney can request a new examination.
When requesting the examination, your attorney can ask for a new doctor to complete it. If the insurance company is unwilling to grant the IME or the request for a new doctor, your attorney can file a formal request with the state labor board to force the new exam and doctor.
Your Refusal to Cooperate
When you file a claim for workers' compensation benefits, you are required to cooperate with the insurance company while it seeks to determine if you qualify. However, if you felt that part of the process was unfair or unnecessary, you might have avoided or refused to cooperate. Without the information needed, the insurance company can refuse to authorize the benefits.
If your lack of cooperation was the reason cited for the denial, there is a simple remedy. Your attorney can arrange for you to complete the task needed by the insurance company. If you have a concern about the reason for the task or believe that it will adversely affect your case, inform your attorney.
For instance, if you had an old injury that you think the insurance company could use to deny your claim, your attorney could ensure that the company only has access to the medical records that apply to your work-related injury. By doing this, you can prevent the company from blaming an old injury and increase your chances of getting approval for your benefits.
Regardless of how clear-cut your workers' compensation case might seem, it is a good idea to talk to an attorney. By having an attorney guide you through the system, you can overcome any challenges to the claims process you might face.