benefits denied

Appealing a Denied Work Comp Claim – Law Office of James M. Hoffmann

August 19, 2017 By James Hoffmann Leave a Comment

Do not let the insurance carrier or your employer deny you benefits.

Workplace injuries are a common occurrence. The average American adult spends 40% of their waking hours in the workplace. The number and types of workplace injuries that occur are many and specific to the job roles, industry and many other factors.

As a result, the government provides workers compensation. These benefits are intended to lighten the burden of medical expenses incurred by the victims and the added burden of loss of wages during treatment and recovery time.

Workers compensation insurance offers no-fault coverage to employees, which means that irrespective of the cause of injury, employees injured in the workplace are entitled to benefits. However, in many cases, injured workers are denied these benefits. In this article, we will explain what workers can do in case they are denied their rightful benefits.

Appealing a Denied Claim in Missouri

In Missouri, all employers are bound by law to have workers compensation insurance and pay for valid claims made by any employee injured at work. However, it is not uncommon for employers to deny workers compensation benefits as it increases their premium.

Injured workers, who have filed a claim and have been denied compensation, should first seek to understand and investigate why their claim was denied in the first place.

If a clerical error on part of the insurance company or the employer has led to a denial of compensation and benefits claim, then the decision of denial can be reversed by the claimant by the means of a simple phone call.

For any other reason for denial, the first thing that an injured worker should do is to consult a St. Louis workers compensation lawyer. There are certain legal procedures and processes entailing filing an appeal that are best followed with legal assistance.

Filing an Appeal

First, it’s important that the claimant understand the process of filing an appeal. The procedure is as follows in Missouri:

A written application requesting a review of the claim should be filed with the Missouri Labor Commission within 20 days of receiving the notification of denial of the claim.
If the Missouri Labor Commission denies the application, the claimant should then send a notice of appeal to the Missouri Court of Appeals within 30 days of receiving the denial notification from the Labor Commission.
The appeal should provide proof that should counter the reason for denial of the claim. This essentially means that if the claim has been denied because the employer claims that the injury did not occur at work, evidence such as videos from surveillance cameras, original accident report and even statements from colleagues can work as evidence. Similarly, if the insurance company denies a claim on the grounds that the injury is not serious enough, proof in terms of medical reports, test results, photographs of the injuries, doctors statements, etc. are valid proof of evidences.

The Law Office of James M. Hoffmann

Gathering evidence, conducting interviews with employers, co-workers and witnesses should always be conducted by an experienced workers compensation lawyer to ensure that correct accounts are provided and documentation is done accurately to ensure just and fair settlement.

Our St. Louis Workers’ Compensation Attorneys can provide you with the necessary information to make the right choices so that you can receive the best medical care, benefits and income. Do not let the carrier deny you benefits. Call us at (314) 361-4300 or fill out our online contact form to request a free consultation.

St. Louis Workmens Compensation Benefits for Deep Vein Thrombosis

February 7, 2017 By James Hoffmann Leave a Comment

A workers compensation claim for DVT can be complicated, requiring the assistance of a St. Louis Work Comp Lawyer.

Deep Vein Thrombosis (DVT) is a blood clot that forms in a vein deep in the body. These blood clots develop when blood thickens and clumps together. Most of these clots occur in the thigh or lower leg. However, they can occur in other parts of the body as well.

Although the precise number of people affected by DVT is unknown, the Centers for Disease Control and Prevention (CDC) states that as many as 900,000 people could be affected in the United States each year. It is further estimated that as many as 100,000 Americans die each year from DVT.

In this article, we will discuss what DVT is and whether or not it is covered by workers compensation.

What is DVT?

DVT is a serious condition that can result in permanent damage to the affected leg veins and their valves, and results in abnormal pooling of blood in the leg. Some other effects of DVT include leg pain, swelling, fatigue, and even severe skin ulcers. DVT can lead to the following permanent conditions:

Leg fatigue
Warm skin
Leg and calf pain or tenderness
Discoloration of the legs
Swelling of the leg
Surface veins become more visible
Pain and discomfort while sitting and walking

DVT can also lead to serious complications if the blood clots in the veins break loose, travel through the blood stream and lodge in the lungs. These blood clots can obstruct blood flow in the lungs and cause pulmonary embolism.

There are a number of ways a healthcare provider can diagnose deep vein thrombosis, but it is most commonly detected by an ultrasound.

Is Deep Vein Thrombosis Covered Under Workers Compensation?

DVT can result from injury or trauma. It has been seen that patients who suffer trauma are at risk of developing DVT and pulmonary embolism. If a worker develops DVT after an injury to the leg, the condition may be considered compensable under workers compensation. However, the worker may have to prove that his/her DVT was a result of an underlying workplace injury.

In many cases, DVT is a result of a side effect of some kind of limb trauma, which can be as minor as a sprained foot or knee. Even orthopedic procedures and surgery of the lower extremities can lead to DVT. In short, you can develop DVT if you have suffered a leg injury, or gone through an orthopedic procedure or surgery of the lower extremity.

Seeking Workers Compensation Benefits for DVT

Now we come back to the original question, whether not DVT is covered by workers compensation. As mentioned earlier, any medical condition, including DVT is compensable as long as it is a result of a workplace injury or the treatment you received for this injury. However, claims involving conditions such as DVT are often complicated, because the insurance company can always contend that the injury is not work-related, and is a result of factors unrelated to the work. So, it is important to seek legal help from a competent and experienced St. Louis work related injury lawyer, who can protect your rights and ensure that you get the rightful benefits.

Do Women Receive Less Workers’ Compensation Benefits in St. Louis?

December 7, 2016 By James Hoffmann 1 Comment

When women get injured at the workplace, they may not be getting the work comp benefits they deserve.

A worker who gets injured at work may be entitled to workers’ compensation benefits. An injured worker generally cannot file a lawsuit against the employer and must depend entirely on workers’ compensation benefits to cover medical costs and lost wages. Workers’ compensation benefits can include ongoing disability benefits in case the injuries have affected the worker’s ability to work. If you have been injured at work, you may face some difficulties in proving that your injury is work-related and getting the benefits that you deserve. In such cases, it is important to seek help from a St. Louis worker compensation lawyer, especially if the injury has affected your ongoing ability to work.

However, in a recent article published in the New Yorker, new evidence suggests that not all workers are being treated equally when it comes to workers’ compensation. When women get injured at the workplace, they may not be getting the work comp benefits they deserve.

Women and Workers’ Compensation Benefits

Several examples are provided of how women workers may be at a disadvantage when it comes to the workers compensation system. According to the article one of the problems is related to the fact that there are higher chances of a female worker being examined by a male doctor after she sustains a work related injury.

The level of injury and disability is determined by the doctors. This directly affects the workers compensation benefits that the injured worker receives. When a female worker sustains an injury, they may be asked to undergo an examination by a doctor specializing in the particular type of injury. When it comes to specialists conducting examinations for common workplace injuries, only 3% of them are females. If a female worker is examined by a male doctor, he may likely underestimate the extent of her pain and impairment, compared to a male patient.

According to the article, another issue is that in some situations female workers are told that they will receive lower benefits for the same injuries that a male worker would have received. This is particularly true in cases of repetitive stress injuries such as carpal tunnel syndrome. Female workers, particularly older women, are considered more vulnerable to these types of injuries. It is often assumed that there are various possible risk factors for females to develop repetitive stress injuries and joint-related injuries, so they should receive less in workers compensation benefits, because the extent of damage that can be traced to work is reduced.

Getting Rightful Workers Comp Benefits

If you think you are being discriminated against, and not getting the benefits you deserve, you should seek help from an experienced St. Louis work injury lawyer.

In Mr. Hoffmann’s 20 plus years of practicing workers compensation law, he has represented clients who have suffered all types of work-related injuries. Our St. Louis legal team can provide you with answers to frequently asked questions regarding Missouri workers’ compensation and will help you get ALL of the benefits you are entitled to receive.

Call us today at (314) 361-4300 or fill out our online contact form to request a FREE consultation.

Influencing Factors & Denied Claims

Workers Compensation Denied by Doctor
Workers Compensation Denied Surgery
Workers Compensation Denied Pre Existing Condition
Workers Compensation Denied Not Work Related
Workers Compensation Stopped Payments
Workers Compensation Disputes
Fired for Filing a Workers Compensation Claim
Workers Compensation Wrongful Termination
MMI Workers Compensation
Disputing Maximum Medical Improvement
Work Comp Accused Me of Fraud
Missouri Second Injury Fund
Person Comfort Doctrine

New OSHA Rule Affects Alcohol and Drug Testing – St. Louis Injured at Work

July 25, 2016 By James Hoffmann Leave a Comment

New OSHA reporting rules require employers to be cautious about how they use alcohol and drug testing.

Employers often require workers to submit to an alcohol or drug testing after a workplace accident. However, new OSHA reporting rules require employers to be more cautious about this testing. Often, employers will have blanket policies in place requiring each worker to be tested for alcohol and drugs. These policies often discourage employees from reporting workplace accidents. This practice is not acceptable under the new OSHA policy.

Drug and Alcohol Testing After a Workplace Accident

The new OSHA rule concerning electronic reporting of work-related injuries and illnesses does not make explicit mention of drug and alcohol testing after an accident; however, occupational experts believe that this policy does not allow the kind of drug testing that is often done after a workplace accident. Some experts are of the opinion that this policy may have a negative impact on worker safety. Employees will know that they cannot be tested for alcohol or drugs after an accident, so they are more likely to indulge in alcohol and drugs.

In clarifying the new rule, OSHA states that the rule does not prohibit drug testing of workers. However, it prohibits the use of drug testing, or the threat thereof, as a retaliation against an employee who reports a work-related injury or illness. The agency further states that drug and alcohol tests should be conducted in a way that complies with both state and federal laws. The employer needs to have a good reason to suspect that the workplace accident was the result of the employee being under the influence of alcohol or drugs.

How Employers Use Alcohol and Drug Testing

The agency also notes that alcohol or drug testing of workers may be required in some situations, but it can also be viewed as an invasion of privacy. If the workplace injury or illness is unlikely to have been caused by the worker’s drug or alcohol use, or if the testing is not likely to detect any impairment at the time of the workplace accident, it is not going to meet the new OSHA rule. For example, if the employer feels that the workplace accident could have occurred because the worker was under the influence of marijuana, there is no conclusive test to prove that the employee was impaired at the time of the accident. This happens because some ingredients of marijuana stay in the system for weeks, so there is no way to tell when exactly the worker used the drug.

Seeking Legal Help for Workers’ Compensation Claims

If you have been injured in a workplace accident and your employer is trying to deny or reduce your benefits, contact a St. Louis injured at work lawyer. Call The Law Office of James M. Hoffmann at (314)361-4300.