Workers’ Compensation Denial Lawyers in Springfield, MO
Has Your Claim Been Denied in Missouri?
When an employee is hurt on the job or diagnosed with a work-related illness, the employer and its workers' compensation insurer must pay the cost of any medical care and wage benefits.
If your employer or insurer makes it difficult to collect benefits in this situation, you need an attorney who knows Missouri workers' compensation law inside and out. With nearly 50 years of professional experience shared by our attorneys helping employees in these matters, our savvy legal team at Webster & Carlton can help.
Why Do Claims Get Denied?
Denials of workers' compensation claims are more common than one might expect. According to some studies, about one in every seven workers' compensation claims is initially denied. There are various reasons for this high rate of denial.
An employer's insurance company could deny an injured worker's claim for many reasons. For example, your insurer and employer could argue that:
- Your accident did not happen at work.
- Your injury is a result of a pre-existing condition.
- What happened was not an accident.
- You failed to report your injury or illness promptly.
- Your conduct contributed to the injury.
Furthermore, certain types of injuries are more challenging to prove as work-related, such as repetitive stress injuries or conditions that develop over time.
Even if the insurer initially approved your claim, sometimes it will stop payment if it believes:
- You no longer need treatment for an injury.
- You have not adhered to the medical plan or have missed appointments.
- Your injury is a result of a pre-existing condition.
Claims also get denied due to incomplete or incorrect paperwork, a common issue when dealing with complex workers' compensation forms. In any of these situations, the insurance companies may refute the claim, asserting the injury is due to non-work-related factors.
What Happens When an Insurance Company Objects to Your Medical Treatment?
While many workers’ comp claims are authorized when you have followed the correct steps, sometimes an insurance company objects to medical care. If your workers’ comp insurer has opposed the treatment you and your healthcare provider believe is necessary, you need to understand what steps to take next:
Determine the Reason for the Objection
If your insurance company discontinues your medical treatment or outright refuses to provide medical treatment, you must determine why.
Some common reasons include:
- Your case has been denied. Your employer may dispute that your injuries are valid or occurred on the job.
- Your employer or insurer believes you have improved to the point where you no longer need care and can perhaps even return to work.
- The insurer feels that you are not complying with medical instructions, such as not following your doctor’s directions, not attending appointments, etc.
In such cases, you must request a written explanation from the insurance company as to why they have objected to your medical treatment. From there, you can take the following steps.
Independent Medical Examinations
Sometimes, the fact that your insurance company has denied your medical care is a misunderstanding or an error, and simply discussing the problem can remedy it. However, if you and your insurer cannot agree, the next step may be undergoing an independent medical examination (IME). During an IME, an impartial doctor will assess you and provide a second opinion about your condition and needed treatment.
Why Do I Need a Missouri Workers’ Compensation Attorney?A workers’ compensation claim can take several months, even years, to resolve, especially if you continue to suffer from the effects of your work-related injury. Your employer and its insurance company will be represented by highly skilled attorneys who know how to exploit an injured employee. You need to level the playing field by hiring a Missouri workers’ compensation lawyer who will fight on your behalf.
What Happens If My Employer Denies Me Workers’ Compensation Benefits?In many cases, your employer or their insurance company will promptly pay any workers’ compensation benefits. But if they deny benefits–or stop paying them before you receive what you believe you are entitled to under the law–then you have the right to file a claim with the Missouri Division of Workers’ Compensation. An administrative law judge appointed by the Division will review your claim and either conduct mediation between you and your employer, or alternatively hold a formal hearing to determine your right to compensation.
What Kinds of Injuries Are Covered?
Under Missouri law, workers’ compensation only covers injuries that arise “out of and in the course of employment.” This includes accidents that occur during your work shift. It also includes “occupational diseases” contracted at work, provided workplace exposure was the “prevailing” cause.
Workers’ compensation is not necessarily limited to injuries suffered at your normal workplace. If your job requires you to travel–i.e., make deliveries or conduct on-site work with clients–you may be compensated for injuries sustained in the course of such travel. However, Missouri workers’ compensation law specifically excludes injuries sustained while commuting from home to work and back, even if you use a company-owned car.
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