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What should I do if my workers’ comp claim is denied?

| Nov 11, 2020 | Workers' Compensation |

Workers’ compensation is there to protect you in case you sustain a serious injury and can no longer earn a living. These funds can replace a portion of your income until you are healthy enough to work again, as well as cover medical bills related to your illness or injury. 

Virginia’s Workers’ Compensation Commission is responsible for overseeing claims and making decisions. You can appeal a denial provided you take the right steps in a timely manner. This guide explains what you should do. 

Determine the reason for the denial

Denied claims happen for a variety of reasons. Perhaps your employer has disputed the claim by stating the injury took place outside of work. The employer may also believe that you played a role in the injury by behaving inappropriately, which can sometimes disqualify a claim. The type of injury can also pose an issue, which is often the case with illnesses linked to increased stress. Lack of medical care will also work against you, as you need a doctor’s evaluation to validate your claims that you are truly injured and/or ill. 

Read the denial letter closely

The letter will provide the reason for the denial, as well as other essential information such as the deadline for filing your appeal. Failure to comply with the instructions in the denial letter could jeopardize your appeal and cause you to lose out on compensation. The information contained within the denial letter will also help you prepare for your hearing. 

Compile evidence

Your hearing will be before a deputy commissioner, to whom you will present evidence and provide witness testimony. Before your hearing, make sure you have evidence in place that disputes the claims made in the denial letter. For example, if the employer disputes injury, you can bring along medical reports supporting your claim. And if your employer disputes that the injury took place at work, you can provide testimony from any witnesses on the scene. The more information you provide, the stronger your case will be.