Workers’ Compensation Denials in Joplin, MO

Denied Benefits? Aaron Sachs & Associates, P.C. Can Help

Missouri's workers' compensation system is designed to provide relief to employees who suffer from work-related injuries or illnesses. But while it serves as an important safety net, not all injured workers who submit claims are easily or automatically awarded benefits. Some receive denials that can greatly jeopardize their ability to make ends meet. 

At Aaron Sachs & Associates, P.C., our Joplin workers’ compensation team has extensive experience representing workers and families who’ve been denied benefits after submitting claims. We know the common reasons why claims are denied, and we know how to help workers evaluate their options for lodging appeals and pursuing the benefits they need. 

If your Joplin workers’ compensation claim was denied, we can help. Aaron Sachs & Associates, P.C. serves clients across Jasper County, Newton County, and beyond, and offers FREE consultations. Request your when you call (888) 287-1046 or contact us online.

Common Reasons for Workers’ Compensation Denials

Worker's compensation is a form of insurance that provides employees who are injured or sickened on the job with financial and medical benefits regardless of who’s at fault for their injuries. 

Unfortunately, the workers’ compensation system can be difficult to navigate and is prone to disputes from insurance carriers that are most interested in protecting their bottom lines. 

As a result, not all claims end up being accepted. Many are denied for a variety of reasons. Some of the most common include:

• Failure to Report Timely. Any worker injured on the job is required to report the injury to their employer within a certain time frame, which can vary by state. Failure to do so can result in a denial because timely reporting is critical for verification purposes. 
• Pre-existing Conditions. If an employee has a pre-existing condition similar to the injury claimed, the workers' compensation insurer may deny the claim, arguing that the injury is not work-related but rather due to the pre-existing condition. The employee may need to provide medical evidence to prove that work-related duties aggravated or exacerbated the condition.
• Discrepancies in Documentation. Accurate and consistent documentation is key in workers' compensation claims. Discrepancies or inconsistencies in an employee's accident reports, medical records, or testimonies can lead to claim denials. Details such as the time, place, and cause of the injury should match across all documents and recounts.
• Employee Classification. Certain classifications of workers may not be covered by workers' compensation insurance, such as independent contractors or volunteers. Misclassification of employees as such can lead to denials. 
• Missed Deadlines. Both reporting injuries and filing claims are governed by strict deadlines. Missing these deadlines is a common reason for denial. Workers should be familiar with the timeline set by their employer's insurance policy or state law to ensure they comply with all requirements.
• Procedural Errors. Failing to follow the correct procedures as outlined by the employer’s workers’ compensation policy can result in a denied claim. This can include not seeing a company-approved healthcare provider or not getting proper authorizations for treatment.
• Injuries or Illnesses Not Being Work-Related. Workers' compensation only covers injuries or illnesses directly related to an individual's job or working conditions. Claims may be denied if insurers believe injuries occurred outside of work or are unrelated to work activities.
• Injuries Arising from Misconduct. If an injury results from an employee’s misconduct, such as being under the influence of drugs or alcohol or engaging in a fight, the resulting claim may be denied. Companies outline specific behavior standards in the workplace, and violations leading to injury often void compensation eligibility.
• Post-Termination Claims. Claims filed after an employee has been terminated or laid off can be problematic. Insurers may assert that the claim was made out of retaliation rather than arising from a legitimate workplace injury.

Steps to Take After a Workers’ Comp Claim Denial

If your workers' compensation claim was denied, acting promptly will allow you to protect your rights and seek the benefits to which you’re entitled. Here are a few important steps:

1. Review the Denial. Your denial letter is not just a notification; it’s a map that details why your claim was not approved and influences what options you’ll have available. Be on the lookout for common issues involving filing errors and other procedural mistakes and try to understand other stated reasons (and your potential rebuttals) as best as you can so you’re able to communicate them to a lawyer when seeking support. Ultimately, a qualified workers’ compensation lawyer will be best positioned to help you review the issues outlined in your denial letter and what they mean in terms of your options.
2. Pay Attention to Deadlines. Just as with filing an initial workers’ compensation claim, time is of the essence if you choose to file an appeal. Deadlines are stringent in Missouri’s workers’ compensation system and missing them could jeopardize your ability to contest the denial. This is why it’s important to contact an attorney as soon as possible after receiving your denial. 
3. Seeking Legal Advice. Securing an attorney should be a priority in any matter involving something as important as workers’ compensation benefits, and especially when you’ve received a denial. Lawyers with experience in this field know the legal landscape, your rights, and how to advocate on your behalf. Like ours, many also offer free consultations that can help you determine if you have a viable path to challenge the denial.
4. Collect Strong Evidence. Whether you and your attorney will be negotiating directly with the insurance carrier or pursuing a formal appeal, it’s important to be prepared and gather the information you need. Medical records, witness accounts, and other supportive documentation can play a pivotal role in the success of your appeal, and your attorney can help by discussing what evidence is needed for your specific issue.
5. Understand the Appeals Process. You have the right to appeal a denied claim (as well as the right to appeal decisions about your benefits that you don’t agree with). In Missouri, the workers’ comp appeals process begins with an application for review by the Missouri Labor and Industrial Relations Commission (which must be filed within a certain timeframe) and may proceed into later judicial appeals. At Aaron Sachs & Associates, P.C., we have ample experience with the workers’ compensation appeals process in Joplin and can help you prepare for hearings before the Labor Commission or the Court.

Independent Contractors and Workers’ Compensation Denials

How a worker is classified in the eyes of employment law and tax regulation has significant implications when it comes to workers’ compensation. This largely comes down to being an employee, who is entitled to workers’ compensation, or an independent contractor, who is generally not covered by workers’ compensation in Missouri.

At Aaron Sachs & Associates, P.C., we help independent contractors explore options for challenging employment misclassifications so they can secure needed benefits. As a firm with a thriving personal injury practice, we can also assist in evaluating other options for recovering compensation, including civil injury claims brought against a negligent party. 

Call For a FREE Case Evaluation: (888) 287-1046

If you've been denied workers’ compensation benefits, one of the best things you can do is to bring your case to an attorney with experience handling these matters. Qualified lawyers like ours at Aaron Sachs & Associates, P.C. can help you evaluate the denial, discuss your available options, and guide you through the next steps.

Our firm has recovered millions of dollars for injured workers across Missouri and is readily available to discuss how we can help you. For a free consultation, contact us.