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Workers Comp Claim Denied?

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Workers Comp Claim Denied

It may come as a shock to many that workers comp claims denied by the insurance company are a regular occurrence.  Even in the event a claim is accepted at the initial stage of the workers compensation process there are other denials that may be forthcoming.  For these reasons it is a good idea to seek out the assistance of a workers compensation attorney.   Workers Comp attorneys only charge a fee if they are successful in recovering money.

You can speak with Baltimore workers compensation attorney Andrew M. Rodabaugh for a FREE consultation   Call Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!

A workers comp claim denied by who?

The workers compensation process can be confusing and at any given time the injured worker may not understand who has the ultimate decision as to whether they have a valid claim and who decides to accept the claim.  The first person with decision making power is the workers comp adjuster.  Chances are that if you have received a workers comp claim denied letter than it came from the adjuster.  On occasion the adjuster will speak to the employer and other employees who may have witnessed the accident. 

The injured worker must also be aware in the event they receive a workers comp claim denied by an insurance adjuster they do not just have to walk away and forget about pursuing the claim.  A claim must then be filed with the workers compensation commission.  The Commission will review the adjusters decision and provide a legal order mandating what the adjuster must do, or the commission may agree with the adjuster. 

In the event the workers compensation commission issues an Order indicating workers comp claim denied they do not have the final say.  The case may then be appealed to the Circuit Court of Maryland.

10 reasons why your Maryland Workers Comp Claim may have been Denied

  1.     The description of the accident on the claim form is not accurate or leads the adjuster to scrutinize whether the accident is one that should be covered under the work comp policy.  How the accident happened, what the employee was doing when the accident happened, where the employee was when the accident took place, and what body parts were injured all have a great affect on whether the adjuster will accept or contest the Maryland workers compensation claim.  Again it is important to note the workers comp claim denied letter from the adjuster is not the end of the claim! 
  2.      There are too many injured body parts on the claim form.  Exposure/expense to workers comp in large part depends on the body parts that were injured in the accident and how many body parts were injured.  The more body parts injured the greater the chance of denial.  It is not advisable to leave injured body parts off of the claim form, however if it may be a good idea to consult a Maryland workers compensation lawyer to determine the best way to fill out the form and if there is another way to seek treatment without adding each body part to the initial claim form The injury was not immediately reported to the employer.  Adjusters often indicate to injured workers their workers comp claim denied because of multiple body parts.  It is important that the injured employee notify the employer as soon as they are involved in a work accident.  The workers comp adjuster will often first contact the employer for verification that an injury did take place at work.  If a supervisor is not available it is a good idea to notify multiple co-workers that you have been involved in a work accident and that you are injured. 
  3.     Workers comp adjusters will not only deny claims but will also deny ongoing medical treatment if they do not have medical records to substantiate the injury and the necessity for continuing treatment.  While a Maryland workers compensation attorney can help obtain medical records on an ongoing basis in these cases, at the outset of the claim there is usually a month or so delay in getting the original medical records.  This may lead to the adjuster issuing the workers comp claim denied letter simply to protect her right to obtain medical records and make an educated decision.  The adjuster can always change their mind later on and agree to accept the claim as compensable.  Again, a Maryland workers comp attorney can be a valuable asset in getting the adjuster to accept the claim. 
  4.     A lack of witnesses will often lead the adjuster to deny claims because the case will then become a matter of credibility on the injured workers part.  Without any corroborating witnesses the injured worker must come off as honest and sincere at the time of the hearing or the case could ultimately be lost.  If there are indeed no eye witnesses it is a good idea to tell multiple employees about the accident. 
  5.     If the injured worker has a history of injury to the same body part then the adjuster may advise workers comp claim denied.  The basis for this denial ultimately hinges on a medical question.  The adjuster will likely arrange an Independent Medical Evaluation (IME) in an effort to obtain an expert medical opinion as to the causal connection of the injuries sustained to the alleged accident. 
  6.     If the employee has a history of multiple injuries or claims then workers comp adjusters are more likely to deny the claim.  Despite the inherent risks in an occupation, it is the opinion of many adjusters that multiple past workers comp claims indicate that the employee may be attempting to game the system. 
  7.     In is inevitable that there may be inconsistencies in medical records or incident reports as to how the accident occurred.  Depending on the workers comp adjuster, even the most benign inconsistency in the medical report can lead to a workers comp claim denied.  It is best that the injured worker right down exactly how the accident occurred as soon as practical so that they can reference that note in the future so to avoid any inconsistent statement. 
  8.     The employers vendetta!  Unfortunately sometimes the decision to challenge or deny a workers compensation claim is the employers decision.  While there are legal ramifications for denying claims for particular reasons denials may occasionally be issued with no explanation.  In these instances it is best to consult a qualified and experienced Maryland Workers Compensation Attorney as soon as possible. 
  9.     There are a number of deadlines in workers compensation cases and the injured worker must ensure to file a claim with the Maryland workers compensation commission within two years from the date of the work accident- the sooner the better.  The longer an injured worker waits to file the claim for, the greater the chances are they will receive a denial. 
  10.     If the injured worker fails to provide the adjuster what they are asking for prior to making the decision on the case one can expect to receive a letter indicating workers comp claim denied.

 

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Francis YWrongful Death Attorney

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Workers comp Claim Denied
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Workers comp Claim Denied
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Workers Comp Claim Denied? Denied workers comp claims occur all too often in Maryland. Adjusters deny workers comp claims for many reasons. A workers comp attorney can help get you the treatment and compensation you need.
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Work Injury Maryland
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