What Does It Mean When My Workers’ Compensation Claim Is Denied?
Navigating the workers’ compensation system can be daunting, especially when your claim is denied. Mark V. Larson, a leading expert in workers’ compensation law at Larson & Dauer, APC, explains the implications of a denied claim and the necessary steps to ensure you receive the benefits you deserve.
When you receive a “Notice of Denial of Workers’ Compensation Benefits” in the mail, your claim has been denied. This notice indicates that you will not receive any workers’ compensation benefits at the beginning of the process. While this can be disheartening, it is essential to understand that denials are pretty standard, especially for cumulative trauma claims. According to Larson, the key is not to give up but to navigate the denial effectively.
Common Reasons for Denial
Insurance companies, particularly workers’ compensation insurers, often deny claims to avoid paying out benefits. For instance, if you file a claim for repetitive stress injuries from typing for ten years, the insurer may deny your claim, hoping you will abandon it. This strategy minimizes their costs, even when the claim is legitimate. Mark V. Larson emphasizes that this denial does not mean your case is unwinnable; it merely indicates that additional steps are required to prove your claim.
Proving Your Claim
When your claim is denied, you must demonstrate that your injuries are work-related. This often involves gathering medical evidence and showing that your work contributed to your condition. Even if you haven’t seen a doctor over the years, you can still pursue your claim with the help of an attorney. Larson highlights that seeing a doctor after filing your claim can be crucial in providing the necessary medical documentation to support your case.
Seeing a Doctor After a Denial
You might wonder how to see a doctor if your claim is denied. Your attorney can help find a doctor who will treat you on a lien basis, meaning they get paid from your settlement. This doctor will start connecting your injuries to your employment, which can help strengthen your case. This step is vital because medical evidence will play a significant role in validating your claim.
Insurance Involvement and Medical Examiners
Once you begin receiving treatment, the insurance company will want to get involved because the medical evidence will show that your injuries are work-related. At this point, the insurer may request an evaluation by a neutral expert doctor, a Panel Qualified Medical Examiner (PQME), or an Agreed Medical Examiner (AME).
- PQME: A doctor assigned by the workers’ compensation system to provide an independent evaluation. The PQME’s opinion is weighed against your treating doctor’s opinion, and if they disagree, the case may proceed to a workers’ compensation trial.
- AME: A doctor your attorney and the insurance company agreed upon, whose opinion is generally considered final. Larson advises caution with AMEs, as their final word will likely be accepted by a judge, making their role pivotal in the outcome of your case.
Navigating Medical Opinions
If the PQME and your treating doctor disagree, the case may proceed to a workers’ compensation trial. However, if you have an AME, their opinion is usually final. Mark V. Larson advises caution with AMEs, as their final word will likely be accepted by a judge, making their role pivotal in the outcome of your case.
Settlement and Trial
The insurance company typically starts paying benefits once you have favorable opinions from the PQME or AME. If disputes persist, a workers’ compensation trial may be necessary. This trial involves a workers’ compensation judge, without a jury, and occurs at the workers’ compensation appeals board. Larson stresses that even if a trial is required, having thorough medical documentation and expert opinions significantly strengthens your position.
Final Thoughts
If your claim is denied, remember that you are not alone. Many cases are initially denied, but with persistence and the proper legal support, you can fight for the benefits you deserve. Mark V. Larson and his team at Larson & Dauer, ALC, are experienced in navigating these challenges and ensuring injured workers receive their rightful compensation. The key is to remain proactive, gather the necessary evidence, and consult a knowledgeable attorney to guide you.
Contact Information
For personalized assistance and to discuss your specific case, contact Mark V. Larson at Larson & Dauer, APC:
- Address: 15545 Devonshire Street, Suite 205, Mission Hills, CA 91345
- Phone: 818-830-1910
- Fax: 818-830-6966
- Website: https://larsondauer.com/mark-v-larson/
Mark V. Larson and his team are dedicated to advocating for injured workers and providing the expertise needed to navigate the complexities of workers’ compensation law. With his guidance, you can ensure that your rights are protected and your claim is handled with the utmost care and professionalism.
