Denied Claims for Workers Compensation

Veteran attorneys, Wade Coye and Dan Smith from the Coye Law Firm, discuss workers compensation and common issues with denied claims.

Wade: "I'm Wade Coye from the Coye Law Firm. I'm here with Dan Smith. We're going to talk about workers' compensation and common issues with denied claims. Dan, one of the things that clients have problems with when they call in is they typically will call when they'd been injured at work and then the carrier says, sorry we're not going to pay for this claim, or they don't provide them with a doctor. What can somebody do in that situation?"

Dan: "A lot of times they can, obviously, contact a lawyer. They may have something in the mail that explains why they're being denied. They can immediately contact their employer and insurance agent and try to figure out a bit more about why their claims are being denied. We see a lot of typical and similar reasons for claims being denied, such as maybe the employer didn't report it, the carrier doesn't think it's a valid claim. Some claims just aren't allowed to be filed, for instance, in certain conditions. Maybe they've gone to a doctor and the doctor thinks that the condition they have is not related to the workers compensation incident they had."

Wade: "Years ago, people would give me a call and say that they've been denied a claim and initially the situation was you would you file a claim for benefits, and you did that immediately. Could you tell a little bit about what's the procedure today that we do that. We know today we do things a little bit differently than what we used to. Used to be a claim for benefits and then there was a request for assistance that used to have to be filed. Let's talk a little bit about what steps are today in 2012 moving into 2013 with the best approach to take when you've been injured at work and what should you do to try to get your claim initiated."

Dan: "Sure, if the claim is being denied, we have what's called a petition for benefits process. Even though it's supposed to be a very simple process it can be difficult, and the process is, you file a petition, you requesting the exact benefits that you want, you may not be getting your wage loss or not getting a doctor, and you request those. You were then given both a mediation date and a date in front of an administrative law judge, in which then you're going to present your claim in front of them and him or her, the judge, is going to make a ruling on your case and say, do you get those benefits?"

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