In Tennessee, workers who have been injured on the job and are worried about the future should understand their rights under workers’ compensation law. If you are in this situation, there will inevitably be concerns that must be addressed. That includes medical treatment, coverage for lost wages, disability benefits, and the possibility that your duties will be modified based on your condition and current capabilities.
However, the benefits must first be approved by the workers’ compensation insurance adjuster. The fears that accompany a work injury and its aftermath can be made much worse by facing a workers’ compensation claim being denied.
Although this might make it seem as though the case is over, it is important to remember that there are options to appeal and have the claim approved. You should make sure to have caring guidance from the start of the case.
How do I appeal if my workers’ compensation claim is denied?
A key aspect of an entire workers’ compensation claim is understanding the process. In the aftermath of the work injury, the basics include informing the employer within 15 days. The employer subsequently files a report to the insurance adjuster. The adjuster will then contact you to begin assessing the claim and determining if it warrants workers’ compensation benefits.
During this time, you will get the medical care necessary to address the injury. If, for example, you have injured your back, you might need x-rays, MRIs, medications, rehabilitative care, and more. While this is being provided, the adjuster will look at the circumstances of the case. There is no guarantee that the claim will be accepted.
The adjuster must have a reason for the denial. In some cases, it is for a simple clerical misstep that can be easily rectified. You might not have provided the necessary medical documentation to show that you were hurt because of your job. Or there could have been a pre-existing medical issue that the adjuster does not feel came about because of your work duties.
It is vital to remember that you have rights even if the claim is denied. The adjuster cannot simply deny your claim without giving a reason for doing so. The justification for the denial will be provided. Even if you gave evidence for the initial phase of the claim, you could provide more evidence as part of your appeal. That includes medical information from the treating physician, specialists and others who have taken part in caring for you after your work injury. Witnesses can explain what they saw. That includes supervisors, colleagues and bystanders.
Mediation is another alternative. This involves trying to reach common ground in the case to resolve the dispute. It can be more cost effective than going to court. It is a private negotiation with a Mediation Specialist from the Tennessee Bureau of Workers’ Compensation. Failing to reach an agreement does not mean the case is over. The injured worker can still seek a hearing with the Court of Workers’ Compensation Claims.
Make sure you have professional help for your workers’ compensation claim
After a work injury, your health, finances and future are all in the balance. While workers’ compensation benefits can be a lifeline, there is no guarantee the claim will be approved when it is first filed. If there is a denied claim, there are ways to appeal and eventually be approved.
You need to make sure to have help from the outset to provide all the necessary information and be aware of the options to appeal. We can provide knowledgeable, caring, hardworking, and experienced representation to try and reach a fair outcome and get the workers’ compensation claim approved either in the initial stages or on appeal.