How Can a Workers’ Compensation Law Firm Help You After a Denial?

Virginia requires most employers to carry workers' compensation insurance. However, the commonwealth's workers' compensation insurers are primarily private, for-profit insurance companies. Although the policies and claim handling are highly regulated, these insurers still deny many claims that they should have accepted.

A workers' compensation law firm represents injured workers as they pursue the benefits they are entitled to under Virginia law.

Common Reasons for Workers' Comp Claim Denials in Virginia

Workers' compensation was created as a safety net for injured employees. In exchange for guaranteed compensation for work-related injuries and illnesses, workers gave up the right to sue their employer for personal injuries in most situations.

The insurers are supposed to accept claims for any on-the-job injury or occupational illness.

Compensation provided by these claims is supposed to ensure the worker can obtain medical care and therapy for injuries and illnesses suffered while working for their employers' benefit. Moreover, it reimburses a portion of the employee's income losses while they recover.

However, to avoid paying these benefits, insurers will use a variety of grounds for denial, including:

• The injury or illness did not result from the worker's employment
• The worker waited too long to report their injury or illness
• The employee refused treatment
• The injury resulted from horseplay or impairment by drugs or alcohol
• The worker willfully violated a known and enforced safety rule without justification

Insurers must explain the reason for claim denials and give the claimant time to respond.

The Role of a Workers’ Compensation Law Firm After Denial

A workers’ compensation attorney can provide valuable knowledge and experience when responding to a claim denial. These lawyers understand Virginia's workers’ comp laws and the procedures for securing benefits for injured or sick workers. After a denial, a workers’ compensation lawyer will provide specific services.

Review the Denial Letter and Identify Legal or Factual Errors

The first step in overcoming a workers' comp denial is to determine the reason given by the insurer. This is not as easy as it may seem, since insurers often use technical or legal jargon that may confuse non-lawyers. A lawyer can review the denial letter and identify the problem with the claim.

In some cases, the insurer denies due to a lack of evidence to verify the claim. For example, if you fell from a ladder and injured your back, the insurer will need evidence that the fall occurred at work and that a doctor diagnosed your back injury.

In other situations, the insurer denies because of its interpretation or application of the law. Thus, an insurer might assert that it cannot pay a claim for injuries suffered in a car crash that happened when you were picking up office supplies because driving was not part of your job duties.

Gather Evidence to Support the Legal Contentions in Your Claim

Whether the denial is based on a factual or legal dispute, the lawyer starts by ensuring the claim includes all the documentation needed to prove your case. As a result, your workers' compensation law firm may gather the following evidence:

• Witness statements from those who saw your work accident
• Medical records containing your diagnosis and treatment plan
• Internal communications and workplace documentation about the accident

This evidence helps the lawyer construct a coherent story to support your case.

Communicate With Insurers and Prepare for a Hearing

The lawyer will present the case to the insurer. In many cases, the additional evidence and legal arguments will persuade it to withdraw the claim denial and pay your benefits.

However, in some cases, the insurer persists in the claim denial. Virginia law gives you the right to a hearing to adjudicate disputed claims. Your attorney will prepare your case for adjudication.

Advocate for You Before the Virginia Workers' Compensation Commission

A workers' comp hearing is similar to a trial. Each side will present witnesses and evidence. A lawyer has the skills to construct persuasive arguments that may win the day. After the case has been submitted, the administrative law judge will consider the evidence and issue a written decision.

Negotiate for Benefits

In some cases, the insurer will agree to pay benefits but dispute how much to pay. For example, if you have been permanently disabled, the insurer may dispute the extent of the disability. A lawyer can negotiate with the insurer to secure medical benefits and wage replacement based on your injuries.

Advise You About Timelines

Virginia's workers' compensation laws set several deadlines for reporting your injury or illness to your employer and filing a claim. A lawyer can advise you about these deadlines and when you might qualify for an exception.

Protecting Your Rights

A lawyer can spot other potential issues involved with filing a workers' compensation claim. For example, your employer is not allowed to retaliate against you for filing a claim. If you are fired or lose hours due to your claim, your lawyer can protect your rights.

FAQ

Who Files the Workers' Compensation Claim?

In Virginia, the worker files the claim by submitting paperwork to the Workers' Compensation Commission.

What Occupational Diseases Are Covered?

Virginia allows workers' comp claims for all diseases caused by your work that do not involve the neck, back, or spinal column. Thus, mesothelioma, hearing loss, repetitive stress injuries, and other conditions caused by long-term exposure are covered.

What Is the Deadline for Reporting an Occupational Disease?

You have two years from your diagnosis to claim benefits for occupational diseases, even if you no longer work for the company where your condition developed.

Contact Commonwealth Law Group for Help With Your Claim Denial

Workers' compensation claim denials do not end your right to benefits. At Commonwealth Law Group, we're here to help. Contact us for a free consultation to discuss how we can fight to overcome your denial and obtain benefits.