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My Virginia Workers’ Comp Claim Was Denied – Can I Appeal?

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My Virginia Workers' Comp Claim Was Denied - Can I Appeal?Getting a workers’ compensation claim denied can be heartbreaking for anyone. 

When the insurance company refuses to cover the recommended medical treatment or pay for benefits while the worker is recovering, the situation can seem quite bleak. 

However, this is not the end of the road. There are other avenues and plenty of other options for the worker to receive the benefits they’re entitled to. Once they receive the notice of denial, the first thing they should do is to contact a qualified and experienced workers’ comp lawyer who can help them navigate the claims system.

Why was My Virginia Workers’ Comp Claim Denied?

Before a worker can start to challenge the denial of their claim, they should first understand why it happened. Here are some of the common reasons workers’ comp claims are denied by employers and insurance companies:

  • The worker failed to inform their employer about the accident and the resulting injury within the prescribed time. Most employers will require a written notice. When the worker does not submit this notice right away, the insurance company may argue that an accident investigation isn’t possible
  • The worker failed to receive medical care or waited weeks or months to seek medical attention. 
  • The worker was injured during his first day at work. The insurance company may deny the claim while they investigate if the worker had sustained injuries previously but waited until they were employed so they can file a workers’ comp claim.
  • The worker filed the claim after they were given disciplinary warnings or terminated from their position.
  • The claim was filed after the statutes of limitations.
  • Virginia is a no-fault state when it comes to worker comp, which means that the worker will still receive benefits even if the injury was partly caused by their mistake or negligence. However, if the worker tested positive for alcohol or drugs after the accident, the insurance company may choose to deny the claim.
  • There is no witness to the accident or injury.
  • The worker was not injured at work. However, the worker may still be entitled to benefits if they were injured while they were performing their duties off-site.
  • The worker refused treatment from the authorized physician or medical provider.

Contesting a Denial of a Workers’ Comp Claim in Virginia

When a claim for workers’ comp has been denied partially or completely by the employer or insurance company, the worker can file a claim with the Workers’ Compensation Commission. This entails a hearing, where the worker and his lawyer will present evidence that supports their claim. The case will be decided by a deputy commissioner, which is the title given to Virginia’s workers’ compensation judges. 

The deputy commissioner will then decide based on the testimonies, documentation, and other evidence presented. If the claim is still denied by the deputy commissioner, the worker can do either of the two: 

  • File a motion for reconsideration so the deputy commissioner can re-evaluate the case
  • Request a review by the full Commission. 

If the worker chooses to do the second option, the full Commission will then review the evidence and written statements provided. They’ll then decide on the case. If the claim is still denied the worker can file an appeal with the state’s Court of Appeals. They can even go up to the state’s Supreme Court in case the petition is still denied. However, most claims do not reach this point.

Contact a Virginia Workers’ Compensation Attorney

Insurance companies will find every reason to deny a claim and protect their interests. At Slominski Law, we understand the frustration that comes from being denied the benefits you’re entitled to. 

We are solely focused on making sure that our clients receive aggressive legal representation when they’re pursuing the compensation they deserve.

If you’re unsure about what to do after your claim gets denied, contact us via email or call us at (434) 384-9400 (Lynchburg Office) or (540) 554-3762 (Roanoke Office) so we can evaluate your case and see if the denial warrants being contested.