What Happens if My Workers’ Comp Claim is Denied?

The workers’ compensation attorneys at Silverman, McDonald & Friedman are proud to represent the people of Delaware in securing benefits when they’re injured on the job. Contact us today for a free consultation in our Wilmington, Newark or Seaford office.

Under state law, Delaware employees are entitled to workers’ compensation benefits (every company that has at least one employee is required to purchase workers’ comp insurance). However, this doesn’t mean that every claim is automatically approved. Many claims are denied by employers – and often.

Denial of benefits means lower insurance premiums for the employer. And that means insurers and employers may be looking for reasons to deny your claim. What happens next?

Reasons an employer may deny your claim

There are several reasons your employer or insurance company could deny your workers’ compensation claim. Following are a few reasons and scenarios:

• You didn’t report your injury or file your claim properly.
• There were no witnesses to support your claim.
• There are discrepancies between your account of the incident and the results of your medical evaluation.
• Your initial medical evaluation shows you were under the influence of illegal substances when you had your accident.
• You did not authorize the workers’ comp insurance company access to your medical records.
• Your employer believes your injury or condition occurred outside the scope of employment.
• Your employer believes that your condition or injury was preexisting.

Of course, there could many other reasons your claim might be denied. If you receive a denial letter, you should consult with a skilled attorney immediately. If your employer disputes your injury, your attorney can begin building your appeal.

If your claim is denied

If your claim was denied due to simple clerical issues or misunderstandings, your workers’ comp attorney may be able to secure your benefits without having to go through the appeal process. However, if your employer will not reconsider, you will have to file a petition for a hearing with the Delaware Office of Workers’ Compensation.

The next steps in the appeals process can include completing pretrial paperwork, being assigned a hearing date, and appearing at a hearing before the Industrial Accident Board. If the Industrial Review Board denies your appeal, you’ll have 30 days to appeal its decision to the Delaware Superior Court. Then, you’ll have a proceeding in court, following all general rules and procedures.

Appealing a denied claim can be a complicated and lengthy process. You can greatly increase your chances of securing your Delaware workers’ compensation benefits by consulting with the tenacious attorneys at Silverman, McDonald & Friedman. Our lawyers represent clients in the Wilmington, Seaford, and Newark areas. Call 302-888-2900 or fill out our contact form today.