What if My Workers’ Compensation Claim Is Denied? 

Accidents can happen anytime on a job site, and this is true even under the best of conditions. And, an important safety net for employees in Missouri who are injured is the state’s workers’ compensation program. This program can provide much-needed help for those who are injured due to no fault of their own, but what happens when you receive a workers’ compensation denial? According to the Missouri Division of Workers’ Compensation, there were 12,670 claims for compensation filed with the state in 2021. And of these, over 1,500 were denied. For help knowing what to do if a workers’ compensation claim is denied, reach out to us at the Law Office Of John Adams Christiansen, LC. We’re located in Kansas City, Missouri but are happy to help those throughout the area, including Blue Springs, Independence, Raytown, Lee’s Summit, Grain Valley, and Belton. 

Reasons a Workers’ Compensation Claim May Be Denied  

All workers in the state should be familiar with their employment contract, and this includes being knowledgeable about workers comp and understanding the reasons a workers’ compensation claim may be denied. One of the most common reasons for denial is simply that you’ve missed your filing deadline. For any injury that happens on the job (even a minor one), you should report it to your supervisor immediately. In Missouri, the law states that this must be done within 30 days of the accident, and you’ll then have two years to file a claim. If you miss this statute of limitations, you risk having your claim thrown out completely.   

Two other common reasons for the denial is that you and your employer disagree on whether the injury actually happened “on the job” or the reported injuries you sustained don’t meet the requirements for filing. In the latter case, this could be because there’s a discrepancy between what you claim your injuries are and what the medical documents say. It’s essential with any work-related injury to seek medical attention immediately and retain all documentation, including diagnoses, treatment plans, and billing statements. Furthermore, it’s imperative that you follow through with all your doctor’s directives as far as treatment and rehabilitation, or else this could be grounds for denial. In all of these instances, it can be extremely helpful to hire a workers’ compensation attorney to help you with your claim. 

Notice of Controversion  

If your claim is denied, you’ll receive a notice of controversion from the adjuster working on your case. Sometimes this means that only a portion of your claim is denied, but other times it could mean that your entire claim is being denied. If this is the case with your claim, you need to know what to do if you get a notice of controversion. Your first step should be to get a third-party attorney involved who can best represent your interests. Many times, employers will have teams of lawyers working on their side, and if they can avoid paying out on a claim, they will. You need someone who will listen to your side of the story, thoroughly investigate the case, then stand up for your rights. You’ll then need to work with your lawyer to file a workers’ compensation appeal. 

What to Do If a Workers’ Compensation Claim is Denied  

Appealing a Decision  

When appealing a denial, you should pay special attention to the deadlines because, in Missouri, you only have 30 days to start your appeal. You’ll do this by filing an Application for Adjudication of Claim with the judge presiding over your case. After you recieve this, you’ll request a hearing by filing a Declaration of Readiness to Proceed. Although this can be done by the individual worker, most people find it extremely beneficial to work with an experienced attorney. A lawyer can help you complete all the paperwork and ensure you have all the relevant evidence and information to mount a successful appeal and get a workers’ compensation settlement offer that adequately covers your needs. 

Accepting a Settlement  

Once your appeal has been filed and reviewed, you’ll receive a compromise and release agreement from the state that outlines their decision, and their proposal for a final settlement. This should be thoroughly reviewed by you and your attorney before you agree to anything. If your injuries are extensive and will take months or even years to fully heal, your settlement should reflect the costs of these ongoing needs and in some cases, should include temporary or permanent disability coverage. 

Seek Trusted Legal Guidance  

Navigating a workers comp claim can be very complicated and is more challenging if your initial claim is denied. For help with this or any aspect of employment law, reach out to us at the Law Office Of John Adams Christiansen, LC, in Kansas City, Missouri. We have everything necessary to get you on the correct path. Don’t face your challenges alone.