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What to do if your workers’ comp claim is denied

On Behalf of | Jul 10, 2018 | Workers' Compensation

Perhaps you work in an industry that is known for its high-risk environment, or you may go to your job each day with no expectations of suffering an injury. However, when you did get hurt or developed an illness related to your job, you took the steps necessary to claim the workers’ compensation Oklahoma law requires your employer to carry for you.

You may have been shocked when you received notification that the insurer denied your claim for coverage. Now what happens? You have medical expenses from your injury and other bills that you fell behind in paying because of the days you were unable to work. It may help you to understand why insurers deny some workers’ compensation claims and what your next steps can be to seek the assistance you need.

Why was my appeal denied?

The letter the insurer sent you should explain the reasons why they decided not to cover your claim. It could be something as simple as failing to supply sufficient medical documentation, in which case you may be able to submit the missing paperwork for reconsideration. Other common reasons why workers’ compensation claims come back denied include the following and others:

  • The injury did not occur while you were engaged in your work duties or occurred as a result of prohibited behavior, such as horseplay on the job or working while impaired by drugs or alcohol.
  • You did not notify your supervisor within the designated deadline, typically 30 days after an injury.
  • You did not file for workers’ comp benefits within the appropriate time frame for your circumstances set by Oklahoma law.
  • You did not seek medical care or follow through with your doctor’s treatment plan.
  • You did not provide evidence that your injury occurred on the job.
  • Your employer claims the circumstances of your injury disqualify you from workers’ compensation benefits.
  • Oklahoma’s workers’ compensation does not cover your illness, such as certain psychological conditions.

If you disagree with the reasons given in the denial letter from the insurer, you have the right to appeal the decision. In fact, the letter will give you details about how to file an appeal and how long you have to do so. Your first step is to approach your employer for clarification of the reasons for the denial.

If the issue is not one you can easily resolve with your employer, you may wish to enlist the aid of an experienced workers’ compensation attorney who can guide you through the appeals process with the goal of obtaining the maximum benefits to which you are entitled.

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