On-the-job injuries can lead to complicated treatment plans and expensive medication. Depending on the severity of the injury, some workers could face costly hospital visits, complex surgery, and lengthy physical therapy. During all this, if the insurance company denied the claim, the cost could be astronomical.
Fortunately, numerous remedies are available after a claim denial.
Grounds for denial
Before seeking the proper course of action for your appeal, you must know the reason for denying your claim. Here are common reasons for denial:
- Failure to report the injury on time
- Missing the deadline to file a claim
- Employer disputes the claim
- The injury is not compensable
- Failure to comply with medical recovery and treatment
- Insufficient proof that the injury is work-related
These are just some of the grounds for denial and there may be other reasons why the insurer denied your claim.
What are my remedies?
Fortunately, Wisconsin laws protect your rights to appeal your workers’ comp denial. Here are remedies you may take to appeal the decision:
- Request a hearing with the Wisconsin Department of Workforce Development to initiate your appeal. An Administrative Law Judge (ALJ) will handle your case.
- If the ALJ denies your appeal, you have the right to challenge their decision to the Wisconsin Labor and Industry Review Commission (LIRC) within 21 days of the decision.
- The Review Commission may deny your claim for the third time. In this case, you can appeal the decision to a state circuit court.
A claim rejection is not a dead-end scenario
All types of rejection could feel like a dead-end. However, there is always light at the end of the tunnel. There are several remedies that workers’ comp claimants can resort to if their insurer denies their claim. Awareness of these options can give you peace of mind.