What Do I Do If My Claim Was Denied?

What if the insurance company doesn’t believe that you have a compensable claim? They’ll deny your case. Let me give some common examples of reasons for denial:

1. First of all, the employer may say that you were not working for them at the time you were hurt.
2. The insurance company may say that you were never hurt at all and that you were lying about your injury.
3. They may say that your injury doesn’t meet one of the three theories of liability under the Workers’ Compensation Act. The Plaintiff has the obligation to show that they were injured by an accident, by a specific traumatic incident, or an occupational disease.
Those could also be reasons why the insurance company chooses to deny your case.

If the insurance company denies your claim, we are going to try and get them to reverse that decision, because that is the fastest way to get benefits for you. If we can’t get them to reverse their decision, we can file a Form 33, requesting a hearing before the Industrial Commission and present your case to a judge who can force the insurance company to award benefits to you.

What happens to you in the meantime? You’re in a very tough position. Workers’ Compensation will not be responsible for paying for any medical bills or for any time out of work. That must come out of your pocket during the period of the denial. We help our clients by seeking low-cost clinics and encouraging them, if it’s possible, to file for unemployment or return to work in a light duty job so you have some monies during this difficult time.