My Workers’ Compensation Claim Was Denied. What Do I Do?
The workers’ compensation system is a no-fault system designed to help injured employees deal with work-related injuries in a fair way. However, the workers’ compensation system is not always fair. Even if you report your work-related injury to your employer on time, submit all the correct forms at the right time, and provide supporting evidence, your employer or their insurer may still deny your workers’ compensation claim. You need to know your rights if you’ve suffered a work injury and your workers’ compensation claim has been denied. This article discusses what you can do if your Vermont workers’ compensation claim is denied.
Why Are Workers’ Compensation Claims Denied?
For you to receive workers’ compensation benefits, your claim must be accepted. In Vermont, the insurance company must accept or deny your workers’ compensation claim within 21 days of your employer receiving notice of your injury. If your workers’ compensation claim is denied, you will get a letter from the insurance company stating the denial and the reason for the denial. The following are some of the most common reasons for workers’ compensation claim denials;
- You allegedly did not report your injury to your employer on time
- Your injury allegedly did not happen at work or within the course of employment
- You were allegedly intoxicated when the injury occurred
- Your injury is allegedly a pre-existing injury
- You are allegedly not a covered employee
What Can You Do if Your Workers’ Compensation Claim Was Denied?
After receiving a claim denial, you can contact the insurer and try to get them to change their decision. You may need to present new information that changes the outcome of your case because often, the workers’ compensation insurer will stand by their original decision. Having an attorney who understands the workers’ compensation system and how to fight insurance companies can be helpful.
If your attempt to get the insurer to change their decision proves unsuccessful, you can consider filing an appeal. Your denial letter will contain an explanation of how you can appeal the decision. However, the truth is that appealing a denied workers’ compensation claim can be complex. Fortunately, a qualified workers’ compensation attorney can help you appeal your case if the need to do so arises.
The first step of the appeal process is usually the Informal Conference. This conference occurs via phone and is conducted by an individual who works at the Vermont Department of Labor (DOL) called a “Specialist.” If you disagree with the decision issued after the Informal Conference, you can request a Formal Hearing. The Formal Hearing is conducted in an informal setting, but the rules of the hearing are formal. During the Formal Hearing, you have the opportunity to present evidence and testimony in front of an Administrative Law Judge. If you disagree with the decision made after the Formal Hearing, you can appeal the decision to the Vermont Superior or Supreme Court, depending on the issue at hand.
Contact a Vermont Workers’ Compensation Attorney
If you need help filing a workers’ compensation claim or appealing a denied workers’ compensation claim, contact our skilled Vermont workers’ compensation attorney at Sluka Law PLC. We can help you recover the benefits you deserve.