What Can I Do If Workers’ Comp Denied My Claim?

October 20, 2021 | Worker's Compensation

Many workers—especially those who work in dangerous industries—are prone to job-related injuries. These workers very often have to work atop high ladders, buildings, scaffolding, and construction equipment. If they fall to the ground, they can suffer debilitating physical injuries to their heads, necks, or backs, which often require emergency medical care and treatment.

In addition, these injured workers might require follow-up care and a lengthy medical treatment plan before they can get back on their feet. All of these medical bills can mount up quickly, and workers may also need to miss a significant amount of time away from their jobs to recuperate from their injuries.

Workers who suffer one or more injuries in the course of their employment should file a claim for workers’ compensation benefits. In some cases, however, these workers’ compensation claims result in a denial for various reasons. If you received a denial of your claim for benefits, it can be stressful, but you have the right to appeal that denial.

Given the time constraints for workers’ compensation claims, speak with a workers’ compensation attorney about your situation as soon as possible after your work accident. A knowledgeable St. Louis workers’ compensation attorney can assist you with every step involved in filing your claim for benefits, settling your claim, and/or appealing your claim denial in the court system. Your lawyer will zealously advocate for you to help you get the benefits that you need and deserve for your work injury.

Types of Work Accidents that Can Lead to a St. Louis Workers’ Compensation Claim

Some work environments are more accident-prone than others. Workers in the construction and building sectors are especially prone to accidents while they are on the job. These workers often have to work around large and heavy construction equipment and vehicles, power tools, and other risky environments. These workers also often work on ladders and scaffolding in many instances, and if they fall from these high places, they can suffer extremely serious injuries.

Although some injuries are soft tissue in nature, such as a muscular sprain, strain, or contusion, other injuries can involve a broken bone, amputation, burns, or severe head trauma. In these instances, the work accident victim can suffer a permanent injury that has a lifelong impact on his or her ability to function and perform daily activities.

Work accidents and injuries do not occur solely in risky industries. In fact, office workers can even suffer severe injuries while they are on the job, such as when office equipment malfunctions unexpectedly or the worker slips and falls on something while at the office.

After seeking first aid or professional medical attention, the first thing you should do after a debilitating work injury is report it to your employer. Your employer can first create an incident report and document all of your injuries and symptoms, as well as the incident itself.

In addition to reporting the incident to your employer, you should seek follow-up medical treatment as soon as possible after your work accident. If you fail to do this, the insurance company for your employer may question the severity of your injuries in any workers’ compensation claim.

Finally, speak with a knowledgeable St. Louis workers’ compensation attorney as soon as possible after your work accident. Your attorney can determine your eligibility for filing a workers’ compensation claim as well as various types of short and long-term benefits.

Eligibility for A Workers’ Compensation Claim After A St. Louis Work Injury

For a person to claim workers’ compensation benefits, he or she must satisfy several requirements. First of all, the worker must be a true employee. Not all workers who receive payment from someone else are employees. Instead, some of these workers are independent contractors.

First of all, an employee will typically receive a W-2 form when it comes time to pay taxes. An independent contractor, on the other hand, will typically receive a Form-1099 at tax time. In addition, employees generally have set working hours and have much less flexibility in how they perform their job duties. They also typically have a regular pay structure. On the other hand, independent contractors usually do not have set hours and have more flexibility in how they receive payment and what they can charge.

Under the Missouri workers’ compensation system, all the employees have the right to pursue workers’ compensation benefits if they suffer injuries on the job. Independent contractors, on the other hand, are not entitled to these benefits if they suffer an on-the-job injury or illness.

In addition to being an employee, a worker must sustain injuries or illness within the scope of his or her employment to be eligible for workers’ compensation benefits and settlement funds. This typically means that when a worker suffers his or her injury or illness, the worker must be on the job and/or performing a job duty or function.

In most instances, traveling to and from work is not considered to be within the scope of one’s employment. Therefore, if a worker is on his or her way to work—or on the way home—and suffers an injury in a car accident, workers’ compensation benefits will not typically be available under those circumstances. However, the injured person might be eligible to file a third-party claim or lawsuit arising from such an accident.

Workers’ compensation benefits are available to injured workers regardless of who caused the accident or how it occurred. Essentially, these benefits are no-fault benefits.

If you suffer injuries or become ill in a work-related accident, speak with a knowledgeable St. Louis workers’ compensation attorney as soon as possible about your accident. Your attorney can determine if you are eligible to recover these various types of benefits. If you are, your attorney can file a claim in the workers’ compensation system on your behalf and pursue the benefits that you deserve for your on-the-job injuries.

Why Workers’ Compensation Claims Might Lead to A Denial

An insurance company might deny workers’ compensation benefits for many reasons. First of all, a denial might happen if the person was not truly an employee. For example, the worker might have been an independent contractor and was not eligible to receive workers’ compensation benefits in the first place.

Second, the accident victim might have suffered his or her injury outside of employment. For example, the individual might have been on his or her way to work when the accident occurred. Alternatively, the worker might have been engaging in non-work-related activities when the accident happened and, therefore, might not be eligible to have workers’ compensation cover this particular injury.

Finally, some accident victims fail to file a timely claim for benefits. In Missouri, under almost all circumstances, workers must file a claim for workers’ compensation benefits within two years of the work accident date. If a claim does not begin within this two-year deadline, the injured worker may no longer recover benefits or any compensation at all from the workers’ comp system.

That is why you should contact a knowledgeable St. Louis workers’ compensation attorney as soon as you possibly can after your work accident. Your attorney can file your claim on time, ensuring that you do not lose your right to recover monetary compensation and benefits for your injuries.

Filing an Appeal in the Court System for the State of Missouri

In some instances, individuals who received a denial of workers’ compensation benefits after filing a timely claim can present an appeal in the court system. As part of this appeal, the court will look at the issue anew and decide whether or not a mistake occurred during the original workers’ compensation claim review. If the claim appeal is successful, then the work accident victim should start to receive various types of benefits.

The right St. Louis workers’ compensation attorney in your area can review the facts and circumstances of your claim denial. Your attorney can then tell you whether or not you can likely file a successful appeal of your workers’ compensation claim denial in the Missouri state court system.

What If Your Current Benefits End Too Soon?

As part of a workers’ compensation claim in St. Louis, Missouri, you might be eligible to pursue and recover various types of benefits. The benefits for which you are eligible will depend on the circumstances of your work accident and injuries. First of all, you might be entitled to recover compensation for all of your related medical expenses. In other words, your employer’s insurance company will pay for all related medical treatment that you incurred as a result of your work illness or injury.

However, there may come a point where the treatment coverage will be cut off, and the employer’s insurer will no longer pay those bills or compensate you for additional medical expenses.

In addition, the injured or ill worker might be eligible to recover a portion of his or her lost wages up to a certain level. If the worker suffered one or more permanent injuries, then he or she may be eligible to recover disability benefits for his or her permanent injury or medical condition. In some cases, workers’ comp insurers will provide disability benefits up to a point but then will state that you should be working again and end your disability benefits too soon.

Finally, if the worker suffered injuries to such an extent that he or she cannot return to the same job or employment, then the worker should receive vocational rehabilitation benefits. Insurers rarely deny these or provide insufficient benefits to help get someone back in the workforce following an injury.

An experienced St. Louis workers’ compensation attorney near you can review the circumstances of your work accident and injuries if your benefits ended too soon. Your attorney can then determine your eligibility to appeal the decision to terminate benefits and help you pursue the maximum benefits you deserve under Missouri workers’ compensation law – for as long as you need them.

Reaching a Final Settlement in a St. Louis Workers’ Compensation Claim

In some instances, an employer and/or the employer’s insurer might offer you a lump sum of money to fully and finally settle your claim. However, in most instances, settling a workers’ compensation claim in its entirety cuts off the accident victim’s ability to reopen treatment—and to have the insurance company pay for that treatment.

Therefore, when you are deciding whether or not to accept a full and final settlement, you should be sure that the settlement will cover any possible medical bills in the future and that the amount will provide necessary financial support. Never accept a settlement and end your monthly benefits without the right legal advice.

Talk to an Experienced St. Louis Workers’ Compensation Lawyer about Your Claim Denial

If you suffered injuries while you were on the job, it can be stressful to have your claim for workers’ compensation benefits denied. Always remember that you have legal options that can help your situation. A knowledgeable workers’ compensation attorney near you in St. Louis or the Metro East can review the circumstances of your work accident claim denial with you, as well as your eligibility for filing a timely appeal.

It is never too soon to call an attorney at 314-208-2808, as the right law firm can help with your initial claim to decrease the chances of a denial. Following a denial, do not wait to take action to protect your rights to benefits. Never leave benefits on the table that can help you and your family.