What to Do if Your Workers’ Compensation Claim is Denied by the Insurance Company in Virginia
The workers’ compensation system in Virginia offers legal protection for employees who get injured at work or suffer from work-related conditions.
Injured workers are often eligible to receive medical benefits and reimbursements for lost wages while they’re recovering. Those who sustain temporary or permanent disabilities may also be entitled to get wage replacement, financial protection, lifetime medical care, and other types of benefits.
However, obtaining these benefits isn’t guaranteed, nor is it an effortless process. The process often takes time, and sometimes, workers may have their claims denied by their insurance company. When this happens, it’s important to remember that denial isn’t the end. There are ways for the worker to fight back and receive what is due them.
Understand Why Your Claim Was Denied
Here are some of the common reasons some workers’ compensation claims get denied by the insurance company:
- The worker failed to notify the employer about the accident and their injury. The law requires injured employees to provide written notice within 30 days or they stand to lose their right to receive benefits.
- The worker failed to file their claim before the Statute of Limitations ran out. Under the law, an injured worker has 2 years from the date of the injury to file a claim.
- The injury was not work-related. The state’s workers’ compensation system only offers coverage for injuries that happen within the scope and course of the employee’s work duties. Any injuries that take place, for instance, while the employee isn’t on the clock or under the influence of drugs or alcohol, may mean that they’re not eligible for benefits.
- The worker isn’t considered an employee under the law, as in the case of contractors.
- The worker has a pre-existing condition that wasn’t affected or aggravated by their injury.
- The worker refused to cooperate with the investigation process of the insurance company.
Generally, insurance companies are looking for any reason they can find to deny a claim, especially if certain details don’t hold up under scrutiny. A good attorney can help look into the denial and go through the steps necessary to appeal this decision.
How to Proceed when Your Workers’ Comp claim has been Denied by the Insurance Company
Once a claim has been denied by the insurance company, the worker has to follow certain steps to ensure the best possible outcome.. Here’s what they should do to contest the decision of the insurance company:
- File a claim form with the state’s Workers’ Compensation Commission and request a hearing.
- During the hearing, the case will be decided by a deputy commissioner—which is the title given to judges handling workers’ compensation cases in Virginia. The deputy commissioner will assess the testimony and documentation presented. After carefully reviewing the case, they’ll make a decision. This decision is usually issued a few weeks after the hearing date.
- In case the claim is still denied by the deputy commissioner, the worker has three options:
- Accept the denial
- File a motion for reconsideration to ask the deputy commissioner to review their decision
- Request a review by the full Workers’ Compensation Commission. In most cases, this option is the worker’s best bet. The commission will then ask for written statements or, in rare cases, schedule an oral argument.
While the appeal is pending before the Commission, the worker should remember the following:
- No benefits will be issued or paid until the claim is completely resolved. Even if the deputy commissioner grants the appeal, the worker may still need to wait a few months before they can get cash payments as the insurance company may also choose to appeal the decision.
- The worker should seek medical treatment on their own. The entire appeals process can take several weeks to months, and some medical concerns need to be addressed immediately. This may be tough for some workers who are going through financial hardship, but the state’s
- Workers’ Compensation Commission relies heavily on documentation, including medical records and statements from doctors.
- The worker should ask for a written work status note from their doctor. This is important if the worker is seeking lost wages or wage replacement benefits.
Contesting a Worker’s Comp Denial? Contact Us Today
Slominski Law has helped countless clients with their workers’ compensation claims. We’ll listen to your side and help you determine whether an appeal is worth pursuing. We’ll help protect your rights and aggressively fight for the benefits you’re entitled to under the state’s workers’ compensation system.
Our Lynchburg number is (434) 384-9400 and in Roanoke call (540) 554-3762. Call today or schedule a consultation by contacting us online.