The average American adult spends about 40 percent of their waking hours at work, so it makes sense that many of the injuries they suffer occur on the job. When you fall off a ladder at home, you understand that you're responsible for your medical treatments and physical recovery.
Likewise, employers in Missouri and Kansas must take responsibility when their workers are injured on the job. They do this by carrying workers’ compensation insurance, which pays the medical bills and lost wages of employees injured at work. These policies provide no-fault coverage, which means the cause of your injury shouldn’t matter.
While it's in an employer’s best interest to provide easy access to these benefits, many often don’t, and workers are unfairly denied benefits.
Why Are Workers’ Comp Claims Denied?
Just because your employer carries workers’ comp insurance doesn’t mean your claim will be automatically approved. Just like any other insurance provider, workers’ comp providers intend to turn a profit, and denial of benefits is one way they protect their bottom line. Your claim could be denied for a clerical error or because the insurer doesn’t believe you're injured.
The most common reasons for claim denials include the following:
1.You didn't report your injury in a timely manner.
2.You missed the deadline for filing your claim.
3.Your employer claims the injury didn't happen at work.
4.Your employer disputes that an overuse injury or exposure illness is work-related.
5.Your injury doesn't appear severe enough to warrant benefits.
Your denial letter should give you a reason for turning down your claim. In nearly every situation, if you were legitimately injured or made ill at work, it's worth appealing the denial and resubmitting the claim.
How to File an Appeal in Missouri
Your next steps depend on why your claim was denied. If the claim was denied due to a clerical error on the part of the employer or insurance company, you may be able to get the decision overturned with a single phone call.
If the denial wasn't this simple, your next move should be to talk to a workers’ compensation attorney. Your denial letter should provide instructions for filing an appeal, but you probably don’t want to proceed on your own. A local attorney will be familiar with the process and able to provide you with the advice and assistance you need to move forward.
In general, the process in Missouri involves the following steps:
- Within 20 days of your notification of denial, you must file a written application for review with the Missouri Labor Commission.
- If you're denied by the Labor Commission, you may file a notice of appeal with the Missouri Court of Appeals within 30 days of the Labor Commission’s denial.
In order for an appeal to be successful, you need to provide evidence to counter the reason for denial. For example, if you were denied because your employer claimed you weren't injured at work, you need to submit evidence proving you were. This might include statements from co-workers, surveillance video, or your original accident report. If you were denied because the insurer didn't believe your injuries were serious enough, you need to produce medical test results, doctors’ statements, and, if possible, photographs of the injuries.
How a Kansas City Attorney Can Help
While it's almost always worth filing an appeal when you are denied workers’ comp, it's usually not worth it to do it on your own. Understanding the reason for the denial, gathering appropriate evidence, and speaking to witnesses and supervisors is best left to an experienced workers’ comp attorney.
If you've been denied workers’ comp benefits in the Kansas City area, contact our workers’ comp legal team. We'll investigate your claim, speak to your employer, and deal with the insurance company. If a formal appeal is necessary, we'll handle all of the filing procedures so you can focus on your recovery. Contact us online or call us directly at 816.471.5111 to schedule a consultation today.