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Workers' compensation claim denials

Suffering an injury on the job can be frustrating, to say the least. Even a minor injury requiring stitches in your hand or a boot on your foot can make it difficult for you to perform the tasks of your job. Medical bills, prescriptions, missed work and other factors may create a financial struggle for you and your family. If your injury is more severe or results in permanent damage, such as a head injury or amputation, you may have many concerns about the future.

Fortunately, Massachusetts workers' compensation provides financial assistance to cover your medical needs and lost wages, among other benefits. You may have felt relief as you completed the paperwork for your coverage and dismay when you learned the insurer had rejected your claim.

Why the denial and what to do next

You have not necessarily exhausted your options after receiving a denial for a workers' compensation claim. Your next step is to file an appeal, and you will have a limited time to do so. However, before beginning this process, it is important to understand the reason why the insurer rejected your claim. Knowing this will help you prepare your argument for appeal. Some common reasons for rejection include the following:

  • You did not report your injury to your employer within a reasonable time.
  • You or your employer failed to file for compensation within the state's deadline.
  • The insurer claims your injury is pre-existing or worker's compensation does not cover your condition.
  • Your employer claims your injury did not occur while you were at work.
  • Your injury occurred as a result of horseplay or your failure to abide by safety rules, or you were impaired by drugs or alcohol at the time of the accident.
  • You did not seek medical treatment or follow through with doctor's orders for your injury.

Appealing your denial for workers' compensation benefits may be as simple as presenting additional evidence of your injury and medical treatment, or it may be much more complicated. In either case, the process is different in each state, and it will be helpful if you have the assistance of a legal professional who is well acquainted with workers' compensation laws in Massachusetts. Your attorney will help you prepare for the appeals hearing and gather the evidence necessary to improve your chances of obtaining the coverage you need.

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