FREE CONSULTATION (573) 341.8336
(573) 341.8336

What To Do When Your Workers Comp Claim Is Denied?

unnamed (16)

In Missouri, most employers are required to provide all employees with workers’ compensation insurance benefits when they suffer work-related injuries or illnesses. Workers’ compensation, also frequently referred to as “workers’ comp,” is a form of insurance that provides employees with payments or lost wages and medical care following on-the-job injuries. However, the workers’ comp claims process can be complicated, and sometimes valid claims are unjustly denied. If you have had a workers’ comp claim denied, there may be legal options for appealing the denial. At Steelman Gaunt Crowley, our team of experienced Missouri workers’ comp lawyers helps our clients fight for the benefits they deserve. Contact us today at (573) 341-8336 to learn more about your legal options.

Common Reasons for Denied Workers’ Comp Claims

Although all injured workers have the right to file a workers’ compensation claim, not all claims are accepted. Some denials are valid, while others may involve the insurance company attempting to limit its liability by finding reasons to deny a claim for a valid work-related injury. When a worker’s compensation claim is denied, the injured worker should understand why.

Missed Deadlines

Each state has deadlines for workers’ compensation claims. The work-related injury or illness must be reported, and claims must be filed with the state workers’ comp agency, within a certain timeframe. In some states, workers must file their own claim, while in others they must first report the injury to their employer, who is responsible for reporting the injury to their workers’ compensation insurance provider.

The Missouri Department of Labor requires employees to notify their employers in writing of their injuries. The employer or its insurer is required to report the injury to the Division of Workers’ Compensation within 30 days of being notified and must report it to their insurance carrier within 5 days of the date of the injury or the date that it was reported. To avoid having a claim denied for a missed deadline in Missouri, it is best to report a work-related injury to your employer as soon as possible.

Non-Work-Related Injuries and Illnesses

In some cases, an employer or insurance carrier may attempt to deny a workers’ comp claim by arguing that the employee’s injury or illness is not work-related. Common arguments may include that the employee was not working at the time of the injury, that they were engaged in some type of misconduct when injured, or that the injury or illness was caused by a preexisting medical condition. 

This is why injured workers should gather ample evidence of their injuries and what caused them as support for their workers’ compensation claims. You can learn more about what to do if you have had a workers’ comp claim denied because of an allegation that the injury was not work-related by contacting the Missouri workers’ comp lawyers of Steelman Gaunt Crowley.

Failure to Seek Medical Care From Authorized Provider

Employers and workers’ comp insurance carriers often have lists of authorized healthcare providers, and any employee who gets injured on the job must seek medical treatment from one of these providers to qualify for workers’ comp benefits. 

Prompt medical attention should always be a top priority following a work injury, but employees should be careful to make sure they seek this care from an authorized provider. Those who receive treatment from an unauthorized healthcare provider may not get the cost of their treatment covered and their entire workers’ comp claim could be at risk of denial.

Drug and Alcohol Use

Workers’ compensation coverage applies to the vast majority of workplace injuries, often including even those that may have been caused by the negligence of the injured employee. However, there may be an exception if the injured employee was under the influence of alcohol or drugs at the time of their accident. An employer or insurer may deny a workers’ comp claim if they have evidence that the employee was intoxicated, and employers also have the right to request an alcohol and/or drug test following a workplace injury.

Can Employees Appeal Denied Workers Comp Claims?

If a workers’ comp claim is denied, the injured worker should not necessarily give up their pursuit of benefits. Denied workers’ comp claims may be appealed. Injured workers should first understand why their claim was denied and determine how to best handle the denial. 

If the denial was based on a paperwork error or another simple issue, it may be possible to contact the claims adjuster to correct the error and get the claim accepted. However, in many cases, denied workers’ comp claims must be appealed if the worker wants a different result. Such an appeal can also be filed if the injured worker disagrees with the extent of benefits offered by the insurer.

How To Appeal a Denied Workers’ Comp Claim in Missouri

The appeals process for a denied workers’ comp claim varies by state. In Missouri, filing an appeal typically involves the following steps:

  • The injured worker will need to file a written application requesting a review of the claim with the Missouri Labor and Industrial Relations Commission. This application must be filed within 20 days of being notified that the claim was denied.
  • If the application is denied by the Missouri Labor and Industrial Labors Commission, the injured worker may send a notice of appeal to the Missouri Court of Appeals. This notice must be sent within 30 days of the Labor Commission notifying the injured worker of the denied application.
  • The appeal should include evidence against the stated reason for the denied claim. For example, if the claim was denied because the insurer deemed the injury non-work-related, the claimant, and their attorney if they have chosen to seek legal representation, must provide evidence to prove that the injury happened at work, such as surveillance footage, accident reports, and witness statements.

Learn More From Our Experienced and Dedicated Missouri Workers’ Comp Lawyers

Injured workers who have had a workers’ comp claim denied may have legal recourse if their injuries should have been covered by their employer’s workers’ compensation insurance. At Steelman Gaunt Crowley, our Missouri work injury lawyers help our clients pursue the workers’ comp benefits they rightfully deserve, from navigating the claims process to appealing denied claims. Contact our experienced and dedicated Missouri workers comp lawyers today at (573) 341-8336 to learn more about what to do if your workers’ comp claim has been denied.