When an employee is injured on the job, workers’ compensation insurance is supposed to provide medical benefits and wage replacement. But times have changed. According to new data, a growing number of initial insurance claims are now denied. One of the reasons this is happening is that states have slashed benefits in recent years, making it harder for injured and ill workers to receive the money they rightly deserve. The only way many of them can successfully recover funds is to contact an experienced workers’ comp lawyer. Here are the five most common reasons they call.
1. Surgery Is Required
Many initial claims are denied because the petitioner requested coverage for a surgical procedure. With less oversight and fewer restrictions on the state level, insurance companies subject most of these claims to close scrutiny, looking for a reason to deny them. In many instances, a petition must be letter-perfect to be approved.
2. Permanent Injury
Those who sustain a serious injury on the job may be entitled to permanent disability benefits. Because these cases can be quite costly, insurance companies set high hurdles that workers and their families must overcome. As such, a reputable workers’ comp lawyer is often needed to successfully petition for lifelong benefits.
3. Pre-existing Disabilities
When an employee with pre-existing disabilities is hurt on the job, he/she often has a much harder time recovering funds than an able-bodied individual. The reason? Insurance companies may argue that the accident was caused by the employee’s handicap rather than by some accident. They may even argue that the accident merely exacerbated the pre-existing disability, but did not cause it. Because these cases almost always involve medical opinions, they can be difficult to prove. It is not surprising that many providers simply reject them, putting the burden of proof on the petitioner.
4. Incorrect Benefits
As difficult as it can be to receive compensation in the first place, it can be even more challenging to have adjustments made after the fact. For recipients who believe they are entitled to additional benefits, successfully redressing the balance of payments can be a Herculean task. A good workers’ comp lawyer may be able to set things right by negotiating directly with the insurance provider.
5. Appeals Are Effective
Although the laws differ from state to state, attorneys have had great success appealing denied claims throughout the land. According to the New Hampshire Department of Labor, for example, almost half of all claims that were initially denied were won on appeal. Similar numbers can be found in most U.S. states. Unfortunately, many employees do not dispute an adverse decision because they don’t know how to proceed. An experienced attorney can be a godsend in this all-too-common legal quandary. Because he/she knows the system and the players, a savvy litigator can help any client determine their best course of legal action.