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When a Work Injury Claim is Denied

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Sthethoscope and medical documentsSometimes a work injury claim is denied by the worker’s compensation insurance carrier. The Indiana law indicates that no compensation is allowed for an injury or death due to an employee:

  • Knowingly self-inflicting the injury or death;
  • Being intoxicated at the time of accident which is proximate cause of the injury;
  • Committing an offense which led to the injury;
  • Knowingly failing to use safety equipment or apparatus;
  • Knowingly failing to obey a reasonably written or printed rule of the employer which was posted in an obvious place;
  • Knowingly failing to perform an official duty of the job which directly led to the injury.

However, it is the employer’s responsibility to prove that such behavior on the part of the employee resulted in his or her work injury. If the employer is able to prove such, then the injured worker is barred from any compensation for his or her work injury.

In other cases, an injured worker’s claim may be denied for reasons that are not so clear. Regardless of the circumstances, all injured workers should receive written notification from the employer if their claim is being denied approximately thirty (30) days after the employer is first made aware of the work accident and injury(s).

Filing a Claim With the Worker’s Compensation Board of Indiana

If a claim is denied, the employer or the worker’s compensation insurance carrier must let the employee as well as the Board know through a written form called a Report of Claim Status/Request for Independent Medical Examination (Form 38911) within thirty (30) days of the employer’s knowledge of the accident.

Thereafter, the injured worker has the right to file a claim on his or her own with the Board, but this must be done within two (2) years from the date of the work accident.

To file a claim, the injured worker must complete and send to the Board an Application for Adjustment of Claim (Form 29109). The injured worker may also want to contact an Ombudsman at the Board for further information about this application.

Medical Treatment

Medical treatment will be on your own if worker’s compensation denies your work injury claim. Your options are to:

  1. Pay out of your own pocket, OR
  2. File with private health insurance.

Keep accurate records of the expenses your accumulate for treatment related to your work injury because this information will be needed if you contest the denial of your claim. If you do contest the fact that your claim was denied by your employer’s insurance carrier, and you file an Application for Adjustment of Claim with the Board, then medical providers who have provided treatment for your work injury cannot try to collect payment from you until it is determined who – either you or your employer’s insurance carrier – is responsible to pay.

In order for medical providers to be considered for payment when the Board determines who is responsible to pay for your medical treatment, the provider should file an Application for Adjustment of Claim for Provider Fee (Form 18487) with the Board.

This rule only applies to those who treat you for the work injury. So, if your credit card company is coming after you for not making the required payments, even if the reason you cannot make these payments is because you are not working now as a result of your work accident, you will not be protected by your worker’s compensation case. Similarly, if you have a collector calling you about a dental bill that is unrelated to your work accident, there is nothing you can do about it through your worker’s compensation case.

Have a question about a denied worker’s compensation claim? Call us at 317.569.9644 for a free consultation to see how we can help.

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