Very often workers’ compensation claims may be initially denied. This does not always mean that the applicant is not eligible. Sometimes, it may be that the employee simply made an error in his or her application for benefits.
Our attorneys at Jay Trucks & Associates discuss why workers’ comp claims may be denied, and what you can do if this happens to you.
If your workers’ comp claim was denied, we strongly recommend that you quickly contact one of our attorneys for legal help. The appeals process is complicated and there are deadlines that must be met to avoid losing out on the ability to obtain the benefits you need.
Contact our firm to learn more about how we may be to help. There is no risk to you since we offer a completely free consultation. If your case has merit and we represent you, there is nothing for you to pay until the end of the legal process. If we do not obtain compensation for you, we do not get paid.
Common Reasons Workers’ Comp Claims Are Denied
While some claims may be denied due to human error, others are denied for various reasons, some of which are valid, including:
- You neglected to file your claim within the deadline: Although employees have two years from the date of the accident to file a claim, Michigan gives workers just 90 days to report a work injury. If you do not notify your employer about your injury within the appointed timeframe, your claim may be denied.
- You do not have medical records to backup your claim of an injury: It is important to seek medical attention immediately after a work-related accident to get the care you need and to provide evidence that links your injury to the work accident.
- The injury was not work-related: If your injury did not happen at work or while you were performing your job duties, you may not have a claim. Additionally, if you waited to get medical care, the insurance company may argue that your injuries could have happened elsewhere.
- Your injuries were pre-existing: You will need evidence from your treating physician to show that your injuries are either new, or that previous injuries were aggravated by the work-related accident.
- You did not follow Michigan’s process for choosing a doctor: Before you can seek treatment from your own physician, you must be evaluated and treated by a doctor approved by your employer’s workers’ comp carrier. Treatment must continue with this physician for the first 10 days after your accident. After that time, you may see a doctor that you choose.
Our Grand Rapids workers’ compensation attorneys understand Michigan’s workers’ compensation laws, and we have extensive experience handling cases that were initially denied. We are prepared to discuss your situation in a free, no-obligation consultation and determine your eligibility for a claim.
Steps for Overturning a Denial
Michigan has an in-depth appeals process that you can access to try to overturn the decision to deny your claim. However, it is important that you act quickly and contact an attorney for legal help as soon as you get your notice of denial. If we determine you may have a valid claim for benefits, our attorneys can guide you throughout the appeals process to help you get the benefits you need.
At a very high level, Michigan’s process for appealing a denied workers’ comp claim includes:
- Using Form WC-104A to request a hearing with the Michigan Workers’ Compensation Agency (WCA)
- Right to mediation – if scheduled by the WCA, for certain circumstances, such as if you are seeking reimbursement of medical costs, claiming benefits after returning to work, or if you have no legal representation
- Attend an in-person hearing or “trial” – this is a more complicated process, and we strongly suggest you seek legal help to improve your chances of overturning the denial
There are additional options that you may be able to pursue if your denial is not overturned during these early steps. However, having an attorney on your side will help to ensure your legal rights are protected and give your claim the best chance of approval.
There is No Risk to Call and Meet With One of Our Licensed Attorneys
At Jay Trucks and Associates, we offer a completely free initial consultation that carries no risk or obligation to you. If we determine you may have a valid case and you choose to hire our firm, we will fight to help you obtain the benefits you need.
Our experienced lawyers are very familiar with Michigan’s complicated WCA appeals process, and we know what information they are looking for in a valid workers’ comp claim. We have a proven track record and obtained millions in compensation for clients who suffered work injuries. While there are no guaranteed outcomes, having legal representation on your side may often benefit a claim.
There are zero upfront costs or fees to pay us while we represent you. We do not get paid unless we obtain benefits for you.
