January 9, 2023
personal injury

Experiencing an injury at work can throw your life into turmoil. Missed paychecks, emotional difficulties, and the long recovery process are just a few things injured workers deal with. The state of Alabama requires workers to follow specific procedures to receive their rightful workers’ compensation.

However, a claim denial is yet another roadblock in the long path toward recovery. But these denials can be fought and appealed. The Alabama work injury attorneys at The Vance Law Firm can provide legal guidance on how to proceed when you receive a denial for your workers’ comp claim.

Why Workers’ Compensation Claims Are Denied

Several reasons may lead to a denial of workers’ compensation benefits. These reasons may include the following:

  • Did Not Report Injury on Time

Upon being injured, Alabama employees must inform their supervisors and employers within 5 days, but no later than 90 days. Delaying your report makes it very difficult for your employer to investigate your accident, which is necessary to process your claim.

  • Insufficient Medical Evidence

Medical records play a significant role in determining whether you have a severe injury or a permanent disability. Without solid evidence, your insurer may assume that the injury occurred before you started working or that a pre-existing condition caused it.

  • Employer Disputes Injury

Your employer can dispute your injury by claiming you weren’t working at the time and that your injury was deliberate. Section 25-5-51 explicitly bars employees from receiving workers’ comp if they intentionally inflicted their injury or the injury resulted from extremely careless or reckless behavior. Your employer or the insurer can deny your claim if they believe that you intentionally hurt yourself or acted recklessly and caused the injury.

How to Appeal a Workers’ Compensation Denial

Upon receiving a worker compensation denial, you can ask for assistance from the Alabama Department of Labor (DOL). However, you can also file a lawsuit in court to appeal it.

Request Help from the DIR

You can have a conference about your dispute with the DOL through the Workers’ Compensation Ombudsman Program. This program is designed to resolve disagreements between you, your employer, and the insurer, including issues with wages and medical conditions.

For instance, the mediator may need to resolve an issue about a denial of authorization for medical services. They can refer a dispute over medical benefits to an independent medical witness for their opinion before making a final decision.

File a Lawsuit

If the employer and insurer refuse to go through mediation, you can file a case in an Alabama District Court. You will need to file a complaint to explain the reasons for the insurer’s denial and the benefits you seek. An insurance company must file an answer after you file your complaint, explaining why you are denied coverage.

Once all the paperwork is complete, you and the insurer go through the discovery phase of gathering and collecting evidence to support your stances. Finally, the court will assign a judge for your case, reviewing all evidence and deciding the verdict.

If a third party’s negligence caused your injury, you must prove that their negligent, reckless, or intentionally harmful behavior caused the accident that resulted in your injuries. A workers’ compensation lawyer can assist you in establishing your case and provide evidence for your claim.

Steps to Take to Strengthen Your Claim

You can take these steps to help you gather evidence to support your case and make your claim more valuable with the help of your lawyer.

  • Visit Your Doctor for an Examination and Diagnosis

A lawyer can help you schedule a doctor’s appointment to diagnose your injury. Tell your doctor you were injured at work and ask them to document your injuries. This documentation can establish a connection between your injury and the accident.

  • Obtain Accident Scene Evidence

Strengthen your case by collecting more evidence, such as a police report, employment records, photos, and video footage. Obtain coworkers’ contact details so your lawyer can interview them about what led to your accident and what your employer did afterward. 

  • Review Medical Authorization Requests from the Insurer

The insurer may request access to your medical records to calculate your claim value and payout. However, they may use it to investigate any pre-existing medical conditions to dispute your claim.

An experienced workers’ compensation lawyer can evaluate any request from the insurance company, ensuring they only receive information related to your workplace injury.

How Can a Personal Injury Lawyer Help?

An experienced lawyer from The Vance Law Firm can assist you in the timely filing of your workers’ compensation claim or understanding the appeals process should your claim be denied.

If you believe the denial of your workers’ compensation claim was unjustified, we can help you navigate the appeal, mediation, or legal process for your claim. We can work to overturn your denial and get you the compensation you deserve for your injuries.

Contact our law office to schedule your free, no-obligation case evaluation.

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