Denial Of Claim And Appeal Process
Denial Of Workers Compensation Benefits – Drug Use On Job
Most states can impose mandatory drug testing on the injured employee, and can deny the employee Workers Compensation benefits if such tests show the employee was under the influence at the time of the injury. Compensation may also be denied where the employee was violating the law or express company policy.
It is not unusual to see the employer challenge the claim on the basis it the accident did not happen on the job or that the injury was not severe enough to qualify as a compensable injury.
Worker Injured But Not In The Course Of Employment – No Workers Compensation Coverage
You will be not be covered by your employers Workers Compensation insurance if you were not working within the course of your employment at the time you were injured. This includes workers who run offsite non-related job errands. For example, if a construction worker was supposed to be delivering supplies to another job site, but instead went with a friend to do something totally unrelated to his job and on his way back from his friends house was involved in an auto accident, the worker will not likely be covered if the accident did not happen while he was in the course of the workers employment. Driving to and from the place of employment is generally considered to be in the course and scope of employment. Driving to or from extraneous non-work relater personal or social visit are usually not covered.
Untimely Filing Of Claim Or Failure To Timely Notify Employer Of Injury
The law is very strict about filing and reporting your claim in a timely manner. In fact, the single most common reasons a claim is denied is because the work accident not reported or filed on time. The law requires that a worker report the claim immediately.
If you submit a workers’ compensation claim and it is denied, you must receive a letter stating specifically why your claim was denied. You still have a right to appeal the decision and it is strongly advised that you retain an experienced workers compensation attorney to handle the appeal for you.
Right To Appeal The Denial Of Your Workers Compensation Claim
The rules and appeals process will be based on your state’s Workers Compensation laws. The first phase of the appeal process will likely be a hearing before an administrative law judge at your state’s Board of Workers Compensation. There are additional levels of appeals which vary depending on your states Workers Compensation Administrative Rules and Appeals Process.
Make sure that your appeal is filed prior to the statutory deadline and that you are fully prepared to present your case, including offering expert medical opinions (usually in the form of current medical reports) which will support the nature and extent of your work injury cliams. Again, if your claim involves a serious injury, at this phase in the administrative process, it is strongly advised that you have a skilled workers compensation attorney representing you.