If you get hurt on the job, you can report the injury to your boss and initiate the workers’ compensation process. However, there are times when your employer or the workers’ compensation insurance company denies the claim. While there are numerous legal justifications for them to do so, it does not necessarily end your case.
Why Would a Claim for Workers’ Compensation Get Denied?
As we will show in our next blog post about workers’ compensation, there are a handful of valid reasons for a workers’ compensation claim to get denied, from being filed too late to being for injuries that did not happen on the job. In some cases, it is pretty clear that the claim should be denied. In many others, though, the justification for a denial is flimsy, at best.
Why your employer or its insurance carrier would try to deny a claim for compensation is simple: Money.
The insurance company’s profit is based on how much more money they earn in premium payments from employers than they pay out in workers’ compensation claims. If they pay out less in claims, they increase their profits. By denying as many claims as possible and paying out as little as they can in the remaining cases, they maximize their profits.
Employers also stand to financially benefit from a denied claim for workers’ compensation. If lots of their workers file workers’ comp claims, the company’s insurance premiums for workers’ compensation coverage is likely to rise. Many employers are willing to absorb that loss in order to help its hurt workers recover. Some are not.
You Have Options if Your Claim Has Been Denied
If you file a workers’ compensation claim with your employer and it gets denied, it is not the end of the case. You have a right to challenge that denial.
The first step is to understand why your claim was denied. You are entitled to a reason for the denial.
In some cases, the denied claim is the result of a clerical mistake. These can often be cleared up and reversed with a phone call, as the insurance company intended to approve the claim.
If the claim was denied for any other reason, though, you will have to file an appeal to challenge the outcome. This generally requires the help of a workers’ compensation attorney.
In Missouri, the appeals process often begins with the Dispute Management Unit at the Missouri Department of Labor. This Unit provides mediation services for disputed workers’ compensation claims. However, it is voluntary: Both you and your employer have to agree to mediate the claim.
An alternative to mediation is to request a conference with an administrative law judge at the Department of Labor.
If the conference or mediation does not resolve your case, or if your employer refuses to partake in the mediation process, the next step is for you to file a claim for compensation with the Department of Labor. This can take your case to a hearing before an administrative law judge for resolution.
If the outcome of the hearing with the administrative law judge is not satisfactory, you will have to file a written application to the Missouri Labor and Industrial Relations Commission (LIRC) to review the denial of the claim within 20 days. The decision by the LIRC can be appealed to the Missouri Court of Appeals.
Workers’ Compensation Lawyers at the Smith Law Office
As you can see, you have a long road of potential challenges if your workers’ compensation claim is denied by your employer or its insurer. The personal injury and workers’ compensation lawyers at the Smith Law Office can guide you through the process. Contact them online or call their law office at (816) 875-9373 for help in St. Joseph, Kansas City, Springfield, or the rest of western Missouri.