The next series of blogs will address denied claims. A denied workers comp claim can happen for several reasons. However, just because a claim is denied does not mean that all hope is lost. First, we will address possible reasons your claim was denied. Next, we will look at the next steps to take to file your own claim with the Workers’ Compensation Board. Last, we will look at what you should do in the interim between your claim being denied and hearing from the Board.
You can visit our office at any point in your workers’ compensation claim process for a free consultation with an attorney. It is important to keep any and all documentation to help in the claim process.
I was injured at work. Why was my workers compensation claim denied?
This blog post aims to address the reasons your employer may deny your claim. If your claim has been denied, you can schedule a free consultation to discuss your claim.
So, you are injured at work, you file a claim, and your claim is denied. A denied claim occurs when your employer or your employer workers’ compensation carrier does not believe your claim is compensable.
Even though workers’ compensation is a “no fault” system, an employer still has the right to deny a claim under certain circumstances.
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 the accident which is the 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.
If your claim is denied, your employer or the workers’ compensation carrier must let you and the Workers’ Compensation Board know through the Report of Claim Status/Request for Independent Medical Examination (Form 38911). Both you and the Board must receive the form within thirty (30) days of the employer’s knowledge of the accident. This form should state one of the above reasons for denying your claim.
So what do these categories mean? Let’s break down the category: “knowingly failing to use safety equipment or apparatus.”
For our example, Bob Builder works installing roofs. Bob’s boss informs him he needs to wear a harness for safety to install roofs. One day, Bob decides to not wear a harness and falls off a roof. It appears Bob was injured at work. However, his boss could still deny his claim under “knowingly failing to use safety equipment or apparatus.” To determine if Bob’s claim should be denied, we ask the following question:
- Did Bob knowingly fail to use safety equipment at the time of the accident?
If Bob knew he was required to wear a harness and deliberately failed to use the safety equipment, Bob’s claim may be denied.
Yet, Bob could still prevail in his claim. Let’s say Bob’s boss informs him he should wear the harness to install roofs, but it is common practice for Bob and his co-workers to not use a harness. And, let’s say Bob’s boss is aware no one uses a harness. Here, Bob could argue his boss knew no one used the harness and the harness was not enforced.
Look at your Form 38911 to see why your employer or workers’ compensation carrier believes your claim should be denied. Now that you understand the why, let’s look to the next steps in the claims process.
My claim is denied because of X, but I do not agree. How do I appeal?
This blog post aims to address the next steps after your claim is denied. If your claim has been denied, you can schedule a free consultation to discuss your claim.
your workers compensation claim denied for reason X and you do not agree. What steps can you take now?
First, be aware of the statute of limitations for you to file a claim. In Indiana, injured workers have two (2) years from the date of the work accident to file his or her own claim with the Workers’ Compensation Board. To file a claim, you must complete an Application for Adjustment of Claim (Form 29109) and send the form to the Board.
Workers compensation claim denied by employer, I filed my own claim with the Board, but I’m still injured. Now what?
If your appeal is denied, your medical expenses will either be out-of-pocket or through your personal insurance.