What to Do if Your Workers’ Comp Claim is Denied

What to Do if Your Workers’ Comp Claim is Denied

After a work injury, the last thing you need is to fight for your workers’ comp benefits. Unfortunately, many people receive wrongful denials of their claims, which can be distressing.

Remember that you have the right to appeal a denial, and the very first thing you should do after a denial is consult with a Kansas workers’ compensation attorney from Pyle Law.

Determining the Reason for Your Denial

Kansas workers’ compensation provides crucial support to employees injured on the job. However, there are instances where claims may be denied. Understanding the reasons behind denials is essential for those navigating the process.

• Failure to report promptly: Reporting the injury in a timely manner is crucial. Delays in reporting can raise doubts about the legitimacy of the claim.
• Missed deadlines: Kansas has strict deadlines for filing workers’ comp claims. Failing to meet these deadlines can result in a denial.
• Pre-existing conditions: If a worker had a pre-existing condition that contributed to the injury, there may be challenges in determining the extent of the work-related injury.
• Disputes over causation: Insurers may dispute whether the injury or illness is directly linked to the job. This can lead to claim denials.
• Lack of medical evidence: Comprehensive medical documentation is essential. Insufficient or inconsistent medical records can lead to claim denials.
• Employer disputes: Employers may dispute the validity of the claim, asserting that the injury did not occur at the workplace or during work-related activities.
• Intoxication or drug use: If the injury occurred while the employee was under the influence of drugs or alcohol, the claim may be denied.
• Misclassification of employment: Some workers may be classified incorrectly, which can impact their eligibility for workers’ comp benefits.
• Independent medical examinations (IME): If an IME report contradicts the treating physician’s assessment, the claim may face challenges.
• Failure to seek timely medical treatment: Delaying medical treatment can lead to complications and may be used to dispute the severity of the injury.
• Injuries outside the scope of employment: Injuries that occur during activities not related to the job may be grounds for denial.
• Inadequate witness statements: Witnesses can play a crucial role in confirming the details of the accident. Inadequate or conflicting witness statements can impact the claim.

It’s important to seek legal counsel if your workers’ comp claim is denied for any reason. Our experienced attorney can navigate the appeals process, gather necessary evidence, and present a strong case to secure your deserved compensation.

Appeal Process for Kansas Workers’ Compensation Denials

When a Kansas workers’ compensation claim is denied, it’s not the end of the road. The state provides an appeal process to ensure that deserving workers receive the compensation they are entitled to. We can navigate the following steps for you.

1. Notice of Hearing – The first step in the appeal process is filing a written request for a hearing. This initiates the formal proceedings to review the denied claim.
2. Pre-Hearing Conference – Prior to the hearing, there is often a pre-hearing conference where both parties, the injured worker and the employer/insurer, may meet with an administrative law judge to discuss the case, attempt settlement, or clarify any issues.
3. The Hearing – The formal hearing provides an opportunity for both parties to present evidence, witness testimony, and arguments. This is a critical phase where the injured worker’s legal representative can present a compelling case to support the claim.
4. Post-Hearing Briefs – After the hearing, the parties may be given the opportunity to submit post-hearing briefs, which summarize the evidence presented and argue the legal points of the case.
5. Administrative Law Judge’s Decision – The administrative law judge will issue a written decision based on the evidence presented during the hearing. This decision will outline whether the claim will be accepted or denied.
6. Appeal to the Workers’ Compensation Board – If either party is dissatisfied with the administrative law judge’s decision, they have the right to appeal to the Kansas Workers’ Compensation Board. This step involves submitting a written request for review within a specific time frame.
7. Review by the Board – The Workers’ Compensation Board will review the case, which may involve a further examination of the evidence and arguments presented.
8. Board’s Decision – The Board will issue a written decision, either affirming, reversing, or modifying the administrative law judge’s decision.
9. Further Appeals – If a party remains dissatisfied, there may be further avenues for appeal through the state court system.

Immediately Consult with a Skilled Kansas Workers’ Compensation Attorney

Navigating the appeal process for Kansas workers’ compensation denials can be challenging. Having an experienced workers’ compensation attorney from Pyle Law by your side can make a significant difference in presenting a strong case and ensuring that your rights are protected throughout the process.

Contact us for a free case evaluation today!