What to Do If Your Workers’ Compensation Claim Is Denied in Delaware

It is currently estimated that nearly 5 million workers’ compensation claims are filed in the United States each year. Workplace injuries are stressful, costly, and can have long-lasting consequences for workers and their families. The only thing worse than getting injured on the job, however, is learning that your workers’ compensation claim has been denied.

Fortunately, a denial is not necessarily the end of the road for workers in Delaware. In some cases, claimants have the right to appeal their denial and continue fighting for the benefits they deserve. At Silverman, McDonald & Friedman, we have over 100 years of combined experience helping injured workers across the state fight for their rights in the wake of a workplace injury. Here’s a brief overview of what you can do if your Delaware workers’ compensation claim is denied and an explanation of how an experienced attorney can help you file a more successful claim.

Why are workers’ comp claims denied?

With so many workers’ compensation claims being filed each year, it’s no surprise that many injured workers feel like they’ve fallen by the wayside when attempting to collect their benefits. Remember: Insurers generally don’t want to pay out the full value of a claim, and they’ll look for any possible reason to issue a denial.

Here are a few common reasons a claim might be denied:

• You missed deadlines: In Delaware, you must report your injury to your employer within 90 days and file a claim within two years of the incident in order to be eligible for benefits.
• You’re lacking medical evidence: If you didn’t seek medical treatment or your doctor didn’t provide enough evidence to support your claim, the insurer may deny it.
• Your injury might not have been work-related: Employers or insurance companies love to argue that your injury didn’t happen on the job. Insufficient medical evidence or delays in reporting injuries can raise questions about whether your injuries were directly attributable to your job.
• You have pre-existing conditions: Insurers might claim your injury stems from a pre-existing condition rather than a workplace accident.
• Substance use allegations: If your employer or insurer suspects drugs or alcohol played a role in your injury, they will likely attempt to deny your claim.

Even if your claim is legitimate, you may receive a denial due to minor paperwork errors or incomplete documentation. That’s why it’s so important for injured workers to partner with experienced legal representation throughout the workers’ compensation claims process. A savvy workers’ compensation attorney can help their clients avoid common mistakes during the filing process and help them cover all the necessary bases when fighting for compensation.

What to do if your workers’ comp claim is denied

If you receive a denial letter, don’t panic – you’re not out of luck just yet. There are several important steps you can take to fight for your rights and potentially reverse the decision so you don’t find yourself navigating your recovery alone.

Step 1: Review the denial letter

Review the denial letter from your employer or its insurance carrier (which must state the reason within 15 days) and was also reported to the Delaware Office of Workers’ Compensation. The letter should contain specific information about why your claim was denied so you can take steps to remedy any outstanding issues. Understanding why the claim was rejected will help you and your attorney determine how best to respond and can serve as an important piece of evidence should you need to take additional legal steps in your fight for compensation.

Step 2: Gather and organize supporting evidence

Many claims are denied due to a lack of evidence. If your denial letter indicates additional evidence is needed to support your claim, you’ll want to begin compiling and preserving relevant documentation, including:

• Medical records (from before and after your injuries developed)
• Doctor’s notes and treatment plans
• Workplace accident or incident reports
• Witness statements
• Employee time logs
• Correspondence with your employer or insurer

Having a strong paper trail will strengthen your case on appeal and help to head off any challenges to your account of the injury and its impact.

Step 3: Speak with a Delaware workers’ compensation attorney

If you have not done so already, this is one of the most important steps you can take to protect the integrity of your claim. A workers’ comp attorney can help you understand your rights, evaluate the basis of your denial, and complete a comprehensive and effective appeal. Your attorney can also represent you during any scheduled hearings and advocate on your behalf during negotiations with the insurance company.

Step 4: File a petition with the Industrial Accident Board (IAB)

If the insurance company refuses to reverse its denial, your next option is to file a Petition to Determine Compensation Due with the Delaware Industrial Accident Board (IAB). This petition starts the formal hearing process and gets the ball rolling in your fight for compensation. You typically have two years from the date of injury to file a petition, but you should always strive to file a petition sooner rather than later. Moving quickly increases your chances of success and helps to cut back on the potential for confounding variables complicating your case.

Step 5: Attend a pre-trial hearing

After filing the petition, the IAB will schedule a pre-trial hearing for your case. During this conference, both parties can present preliminary evidence and arguments. This pre-trial hearing is largely a procedural step, but it will give you a good idea of what’s to come. After the pre-trial hearing, a date will be set for your formal hearing so you and your attorney can begin the necessary preparations.

Step 6: Attend your formal IAB Hearing

During a formal IAB hearing, both sides will present evidence and testimony. You will also likely be asked a number of questions during the hearing to help the Board better understand the facts of the case and assess whether your testimony seems credible. An experienced workers’ compensation lawyer will advocate on your behalf and help present your case in the best light during these proceedings in the hope that the IAB will make a determination in your favor.

Once the Board arrives at a decision, you will be notified in writing of their ruling. If your appeal is successful, you’ll receive the compensation you’re owed. If it’s denied again, you may be able to take your case to the Delaware Superior Court for further review.

Fight back against a denied workers’ comp claim

Focusing on your recovery is hard enough without the added stress and strain of a drawn-out insurance battle. At Silverman, McDonald & Friedman, we understand how frustrating it is to have your workers’ compensation claim denied. That’s why we are proud to stand with workers in Wilmington, Newark, and Seaford.

If you’ve had a workers’ compensation claim denied after being injured on the job, our attorneys are ready to help you appeal the decision, gather the evidence you need, and fight to make your voice heard. Contact us today or fill out our online form to schedule your free consultation, and let’s discuss how we can work together to help you secure the workers’ compensation benefits you deserve.