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What Happens if An Employer Rejects a Workers’ Comp Claim?

Orgeron & Associates April 14, 2021

As an injured worker, you depend on your employer to provide workers’ compensation coverage. After you get hurt on the job, you make a report to your manager. They have to fill out internal paperwork and then submit documentation to their workers’ compensation insurance company within 10 days of the incident or your report to them if the issue is a work-acquired illness.

Unfortunately, depending on your employer leaves you vulnerable. They could refuse to send the claim to their insurance company or send the claim along with their own assertion that your situation doesn’t justify benefits. What rights do you have if your employer tries to deny your workers’ compensation benefits claim in Louisiana?

Injured and Sickened Workers Have the Right to Appeal Denied Benefits

It is not fair or even legal for your employer or their workers’ compensation insurance company to deny you benefits for a qualifying condition. If your employer won’t work with you or the company declines to cover your care, you may have no choice but to initiate an appeal.

You will have the right to present your case to a workers' compensation judge. Everything from records of what happened at work to reports from the physician overseeing your care can help convince a judge that you deserve benefits. If the judge rules in your favor, you can start receiving benefits. You may need to submit claims for reimbursement for any medical care you have already received. You can receive disability benefits going back to the date of your injury or initial application.

If the judge doesn’t approve your appeal, you could always take things higher through an appeal to the Circuit Courts.

Little Mistakes Can Cause Major Delays

Although some insurance companies will challenge a worker’s claim out of greed, others have more legitimate grounds for their behavior. Mistakes that someone makes in their early application or a failure to report an incident right away could leave someone fighting an uphill battle for the benefits that they desperately need.

Workers in need of workers' compensation benefits who get professional help are less likely to make mistakes early in the process. Those already dealing with the denial may find that legal assistance now will make the appeals process more accessible.