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What Should I Do If My Workers’ Comp Claim Is Denied?

Offered by Darrell Castle & Associates, PLLC

A Tennessee workers’ comp attorney can fight for a successful appeal

Workers' compensation in Tennessee is a safety net designed to support employees who suffer work-related injuries or illnesses. If you sustained an injury on the job, it provides financial assistance for medical expenses, rehabilitation costs, and lost wages.

However, the process of filing a workers' compensation claim in Tennessee can be complicated. Sometimes, a claim might be denied despite following all the necessary steps. This can be a significant setback, both financially and emotionally. 

It’s important to understand why claims are denied and what steps you can take afterward to appeal this decision. An experienced Tennessee workers’ compensation lawyer can walk you through the steps to appeal your denied claim and seek the compensation you’re entitled to under the law.

What causes workers’ compensation claims to be denied?

There are many reasons why your workers’ compensation claim may be denied. When you receive a denial letter, it will outline the specific reasons and provide information about the appeals process.

A denied workers’ compensation claim may be due to: 

  • Insufficient medical evidence: Claims are often denied due to inadequate medical documentation linking the injury to your workplace. Insurers may argue that the evidence provided doesn’t sufficiently prove that your injury occurred as a direct result of your job.
  • Non-work-related injury: Your employer’s insurer may claim that your injury is unrelated to your employment. This can occur if there is confusion about when or how the injury happened or if you suffer from a pre-existing condition.
  • Missed deadlines: If you failed to report the injury to your employer within the required timeframe or didn’t file the claim promptly, this could be grounds for denial. In Tennessee, you must report your work injury to your employer within 15 days and file your claim within one year from the date of your work-related accident or injury. 
  • Employer disputes the claim: Your employer might assert that your injury didn’t happen at work or was the result of misconduct. These disputes can lead to a claim denial if the insurer sides with your employer.

A denied workers' compensation claim can have serious repercussions for an injured worker. Financially, it means losing out on essential benefits that cover medical bills, rehabilitation costs, and lost wages. This can lead to significant financial strain, especially if the injury prevents you from working and earning an income.

A denial can also be distressing and frustrating, as it feels like an added burden during an already challenging time. The stress of handling medical treatments, recovery, and financial concerns can be overwhelming without the support of workers’ compensation benefits.

Finally, without proper medical treatment funded by workers’ compensation, your recovery might be delayed, potentially leading to long-term health issues. This is why it’s so important to consult an experienced workers’ compensation attorney who knows how to handle the appeals process in Tennessee.

How do I appeal a workers’ comp decision in Tennessee?

Building a case to appeal a denied workers’ comp claim may involve:

Collecting and preserving evidence

To successfully appeal your workers’ comp claim decision, you’ll need to obtain medical documentation that links your injury to your workplace. This may include detailed doctor’s notes, diagnostic test results, treatment plans, and any other relevant medical records.

If there were any witnesses to your injury, ask them to provide written statements detailing what they saw. These statements can reinforce your account of how your injury occurred and support your claim.

Ensuring all paperwork is accurate and complete

Double-check all the paperwork submitted with your initial claim for any inaccuracies or missing information. Correcting these errors and providing complete documentation can address any administrative issues that might have led to the denial.

This includes the claim form, medical reports, the employer's incident report, and any correspondence related to the claim. Ensure that each piece of information is consistent across documents and accurately reflects the details of your case. If new medical information or evidence regarding your injury or treatment has come to light since the initial filing, include this in your appeal. 

Filing the appeal

After gathering additional evidence, the next step is to file an appeal. You’ll need to complete the Notice of Appeal provided by the Tennessee Bureau of Workers’ Compensation and submit it within 30 days of receiving your denial notice.  

Any errors or missing information on your Notice of Appeal can delay the process and potentially result in a poor case outcome. Take some time to review your Notice of Appeals meticulously before submitting it. 

If you discover any errors, take steps to correct them promptly. This may involve submitting updated forms, providing clarification, or obtaining additional documentation from medical providers or other relevant sources.

Attending an appeal hearing

After submitting your Notice of Appeal, you’ll need to be prepared for the appeal hearing. You’ll receive a notice from the Tennessee Bureau of Workers’ Compensation informing you of the hearing's date, time, and location. Before the hearing, review your case file and gather any additional evidence or documents to support your claim. 

The hearing will likely be conducted in front of an administrative law judge. Both your attorney and your employer’s representatives may present evidence, testimony, and arguments. You may be asked to provide sworn testimony regarding the details of your injury, medical treatment, and any other relevant information. 

Witnesses, such as your doctor or co-workers, may also testify. Expect the opposing party to cross-examine you and any witnesses you bring forward. Be prepared to answer questions regarding your injury, medical history, and work-related activities. 

The judge will then decide based on the presented evidence. Having an attorney can help you prepare your testimony, cross-examine witnesses, and present your evidence in a compelling manner.

Why hire a workers’ comp attorney if my claim was denied?

Tennessee workers’ comp law is complex, with specific rules and regulations that must be followed meticulously. An experienced workers’ comp attorney understands these nuances and can help you navigate the legal system effectively. They can identify any errors or omissions in your initial claim that might have led to the denial and take steps to rectify them in the appeal process. 

Again, one of the critical roles of a workers’ comp attorney is to gather and present compelling evidence to support your appeal. This includes obtaining detailed medical records, securing witness statements, and collecting any additional documentation that can strengthen your case. Attorneys know what evidence is most persuasive and how to present it in a way that maximizes your chances of a successful appeal.

Remember, the appeals process involves multiple steps, and each step has its own set of requirements and deadlines. A workers’ comp attorney ensures that you meet all these requirements and deadlines, preventing any procedural missteps that could jeopardize your appeal. 

If your appeal proceeds to a hearing, having an attorney represent you can significantly impact the outcome. Your attorney will prepare your testimony, cross-examine witnesses, and present your evidence. They will also counter any arguments made by your employer or their insurer, ensuring that your side of the story is thoroughly heard and understood.

Contact a verified workers’ comp attorney in Tennessee today

Dealing with a denied workers’ comp claim can be stressful and overwhelming. An attorney provides not only legal help but also emotional support throughout the entire process. They can answer your questions, address your concerns, and provide reassurance during a challenging time. 

Ultimately, a workers’ comp attorney’s goal is to maximize the compensation you receive. They understand the full extent of benefits you are entitled to and will work to ensure you obtain them. This includes not only medical expenses and lost wages but also any additional benefits you may be eligible for under Tennessee law. 

To get started and learn more about your potential legal options, contact a verified Tennessee workers’ comp lawyer today for a free consultation.

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Founded by attorney Darrell Castle, our firm helps people in Memphis and throughout Western Tennessee who are experiencing hardships, from injury to financial troubles. We are kno...