If your claim has been denied, ask these 5 questions to figure out if an insurance company has reasonable cause to dismiss it or not.
Workers’ compensation insurance is a type of insurance policy that is meant to protect workers in the St. Louis area. It is also a type of coverage that seeks to keep businesses safe from bankruptcy, should a worker have a severe accident.
If an employer has workers’ compensation insurance, then the law works under “exclusive remedy,” which means that a worker is not allowed to sue their employer in a court of law.
There are good reasons that an insurance company is legally able to deny someone workers’ compensation coverage, but that does not mean insurance companies are always accurate in their decision. If your claim has been denied, then you need to ask these 5 questions to figure out if an insurance company has reasonable cause to dismiss it or not:
1 – Are you an employee?
To be eligible for workers’ compensation benefits you have to be an employee. If the insurance company is claiming that you aren’t, there is a way to prove that you are. If you collect a W2 tax form, then you are an employee. Even if you don’t have the proper documents, there might be conditions that still make you eligible.
2 – Were you engaged in work-related activities?
To collect workers’ compensation, you can be at-fault for your injury, but you do need to be engaged in activity that is both under the authority and the scope of your employment duties. If you were doing anything other than work-related activities at the time of the injury, then you might not be eligible for benefits.
3 – Are your injuries as extensive as you claim?
Can you prove medically that your injuries are as extensive as you have stated on your workers’ compensation claim? If the insurance company is requesting an independent medical evaluation (IME), then they are probably questioning if your injury is as severe as you say, or if you are injured at all.
4 – Did your employer have workers’ compensation insurance?
To collect workers’ compensation benefits, your employer must have workers’ compensation insurance. If they do not have insurance, then you might not be able to collect workers’ compensation benefits, but it might open your employer up to be sued for personal injury.
5 – Was your injury a pre-existing condition?
If your injury is combined with a pre-existing condition, then the insurance company might try to say that it was the pre-existing condition that was to blame for your injury (opposed to blaming the work-related accident). If you do have a pre-existing condition, then do not worry, it does not negate your eligibility.
Contact a Workers Compensation Attorney
If you have been injured at work and are being denied, contact the Law Office of James M. Hoffmann. For more than 20 years we have been helping work accident victims receive the compensation they need and deserve. You should be receiving treatment for ALL of your injuries, not just the ones the insurance company wants to accept. Do not let the carrier deny you benefits. Call us today at (314) 361-4300 or fill out our online contact form to request a free consultation.