Fact Checked Navigating initial steps to take after a claim is denied can be overwhelming with the limited guidance that is provided by the worker’s compensation insurance company. It is common for worker’s compensation insurance companies to hire “independent” physicians to deny a claim. The insurance company has a legal right to rely on these second opinions. These denials are particularly challenging while an injured worker is actively treating for the work injury.
Importantly, the injured worker still has a right to continue medical care through their own insurance source and rely on their own treating physician’s return to work recommendations. Out-of-pocket medical expenses (deductibles or copayments) can be pursued as part of an injured worker’s appeal. When medical bills are processed by group health insurance, the injured worker can avoid surprise outstanding bills from the medical providers down the road.
In addition, a denied claim means that the worker’s compensation insurance company will stop paying lost wages to the injured worker. It is important for the injured worker to inquire whether short-term or long-term disability coverage exists. Although these policies offset the worker’s compensation claim, they provide wage replacement for the injured worker if they continue to be off work.
It is important to speak to an experienced worker’s compensation attorney about practical steps to take at the onset of a denied claim.
