Receiving notification that your workers' compensation claim was denied is both shocking and discouraging. Typically, when a claim is denied it's because the insurance company decided that your injury does not meet the necessary standards and therefore shouldn't be covered by workers' compensation. This is upsetting because you know in your heart that your injury was legitimately sustained at work and you don't understand how they could disagree.
Why was your claim denied?
The following are common reasons workers' compensation claims get denied:
- Claim was not reported on time: South Dakota law states that injuries must be reported via written notice within three days of the accident. Most states have a much more relaxed deadline but South Dakota is very strict, report your injury ASAP.
- Employer disputed the claim: Your employer might claim that no accident occurred at work or that your current injury is not a result of said accident.
- Injury is not eligible for compensation: Claims made for stress-related injuries are usually difficult to prove.
- Never received medical treatment: It will be tough to prove the validity of your claim if you've never received medical care. All employees hoping for injury compensation must see a doctor.
- Not enough evidence: The insurance adjuster will conduct an investigation into your claim, your claim could be denied if they are unable to find evidence of an accident. Getting an additional medical exam might help. Also, did anybody witness the accident? If so, would they be willing to provide a written statement?
What should you do if your claim was denied?
Employees have the opportunity to appeal a workers' compensation claim after it's denied. Appeals can be challenging to win, give yourself the best chance possible by hiring an attorney who focuses on workers' compensation cases. They will understand the ins and outs of these cases and be able to curve your expectations and offer helpful advice along the way.