Workers’ Compensation Denials in Columbia, MO

Fighting For the Benefits You Deserve

Navigating the complexities of workers' compensation can be challenging, especially when your claim has been denied. Fortunately, there are ways to fight back after a claim denial – and proven attorneys who can help.

Aaron Sachs & Associates, P.C. is a nationally recognized law firm known for fighting on behalf of injured victims and workers across Boone County and Mid-Missouri. Backed by decades of legal insight, we’ve helped countless clients secure needed workers’ compensation benefits, and have helped numerous folks prevail in claims following denials and disputes.

If your workers’ compensation claim has been denied in Boone County, now is the time to speak with a proven lawyer. Our Columbia attorneys offer FREE consultations and are readily available to help. Give us a call at (888) 287-1046 or contact us online.

Common Reasons Why Workers’ Compensation Claims Are Denied

Workers' compensation is a form of insurance designed to provide wage replacement and medical benefits to employees injured or sickened on the job. In Columbia, as in the rest of Missouri, the system operates on a no-fault basis, which generally allows employees to receive benefits without the need to prove fault.

While workers’ compensation is a valuable safety net for workers and their families, it’s still a process notorious for complexities and disputes. As a result, it’s not uncommon for workers’ compensation insurance carriers, which are corporations more concerned about profits than people, to deny claims.

There are many reasons why claims get denied. Some of the most common include:

• Failure to Timely Report Injury. Missouri law requires employees to report work-related injuries to their employers within 30 days of the incident. Delayed reporting can lead to skepticism regarding the validity of the claim and subsequent denial. In the absence of prompt employer notification, workers may need additional evidence to support details about when, where, and how their work injury occurred.
• Pre-existing Conditions. If you have a pre-existing condition similar to the claimed work injury, insurers may argue that work duties work did not cause the injury and deny the claim. If your case involves pre-existing injuries, you’ll need to differentiate them from your work injury or provide ample evidence as to how your work duties aggravated your condition.
• Documentation & Procedural Errors. Accurate and consistent documentation is vital in a workers' compensation claim, as is following correct procedures. Any errors, missing signatures, or inconsistencies between medical records, accident reports, and your claim can raise suspicions and serve as grounds for denial.
• Employee Classification. Contractors, freelancers, and volunteers often do not qualify for workers' compensation under traditional employee designation. Misclassification of your employment status can lead to a denied claim.
• Injuries or Illnesses Not Being Work-Related. For a claim to be valid, the injury or illness must be directly related to your job and arise from the course of employment. If there's not enough evidence to prove this connection, the claim might be denied.
• Injuries Arising from Misconduct. If an injury results from an assault, intoxication, or other forms of misconduct at work, the claim can be rejected as such actions fall outside the scope of employment.
• Post-Termination Claims. Claims filed after you've been terminated or laid off may be denied, particularly if there was no prior report or indication of injury while employed.

Steps to Take After a Workers’ Compensation Claim Denial

If your workers’ compensation claim was denied, there are steps you can take to fight back:

1. Find an Attorney. Following a claim denial, you’ll want to enlist the support of a qualified workers’ compensation attorney. Workers' compensation laws and the appeal process in Missouri are complex. An experienced attorney can provide invaluable guidance, helping you to understand your legal rights and the best course of action. 
2. Identify the Reason for Denial. One of the most important things you can do is after a denial is to identify the underlying reason. Sometimes, there are valid, though correctible errors in initial claim filings. Other times, there are deeper issues that require further action and advocacy. Our Columbia workers' compensation attorneys at Aaron Sachs & Associates, P.C. have handled cases involving denials based on many different reasons – including some that were justified and some that constituted bad faith – and know what it takes to help workers.
3. Gather Evidence. You and your attorney can work to gather any evidence and documentation that addresses issues behind your claim denial. This may be existing information that wasn’t provided in your initial claim, or new supporting evidence and documentation from different medical professionals, witnesses with knowledge about your injury or employment, and more.
4. Explore Your Options to Negotiate a Resolution. Before formally appealing, you may have the option to negotiate a settlement with the insurance company. Your attorney can help facilitate these discussions, address or rectify issues cited by the insurer when issuing your denial and pursue a resolution that might be faster and more favorable than a formal appeal. Sometimes, a settlement can be reached through mediation or arbitration.
5. File an Appeal. If negotiations do not result in a settlement, or you wish to proceed to an appeal directly, you will need to file a formal appeal with the Missouri Workers' Compensation Division. There are strict deadlines for filing an appeal, so it is crucial to act promptly. The workers’ compensation appeal process in Columbia generally involves preparing a written appeal that outlines the grounds for your case, submitting the appeal, and attending an evidentiary hearing where an administrative law judge will review all evidence and arguments and issue a decision. In some cases, appeals can proceed to a review by the Labor and Industrial Relations Commission or judicial reviews by the Missouri Court of Appeals or Missouri Supreme Court. 

Contact us online or call (888) 287-1046 to request a FREE case evaluation.