State law requires all employers with at least five employees (or one or more employees if in the construction industry) to provide protection to all their workers. Should you suffer an injury within the scope of your employment, there is a substantial chance that your employer and its workers’ compensation insurer are required to provide you with benefits for necessary medical treatment and additional compensation.
Sadly, denials of these benefits are common. Despite these denials, appealing a workers’ compensation decision in Columbia is well within the rights of local employees. Regardless of the stated reason for a denial, filing a Claim for Compensation is the only way to reverse this devastating result.
Insurance companies can deny workers’ compensation benefits for many reasons. Perhaps the most common example is a lack of a connection between doing one’s job and the injury or illness. Missouri Revised Statutes §287.020 provides that a workplace accident is an unexpected traumatic event or unexpected strain that occurs during a single work shift. If an insurance company does not make this connection, they will likely deny the claim.
Similarly, you may be entitled to collect benefits by showing the presence of an occupational disease. Under Missouri Revised Statutes §287.067, this is a medical condition, such as cancer, that arises out of doing one’s job. Insurance companies may have difficulty making the connection between the workplace and these diseases and deny your claim.
Workers’ compensation insurance companies have a variety of additional justifications for denying coverage. These can also include a lack of notice to an employer, a failure to follow up with medical treatment, etc. However, just because a profit-driven insurance company has denied your claim, it does not mean that you are not entitled to benefits. Appealing a workers’ compensation decision in Columbia could yield workers the benefits they were previously denied.
Regardless of the stated reasons for a denial, all workers have the right to pursue a claim with the Missouri Division of Workers’ Compensation. Understanding how to file a claim and receive the compensation you deserve can be complex and overwhelming. Despite its desire to be a simple system, the process involves complicated legal procedures and hearings before Administrated Law Judges. Insurance companies are always represented by experienced lawyers who are motivated by keeping you from earning the full compensation you deserve.
An injured worker may file a request for a full hearing before an Administrative Law Judge. At a full hearing, the judge will listen to testimony, collect documentary evidence, and make a final ruling as to what benefits are appropriate. Before the worker can get their case to a full hearing, the Missouri Division of Workers’ Compensation may hold severe pre-hearing sessions in an attempt to check the status of the case and resolve any issues prior to a full hearing.
Even if a judge does not return a favorable decision, parties can still pursue a further appeal with the Labor and Industrial Relations Commission. This Commission can review the decisions of the Administrative Law Judge to determine credibility of witnesses and if any error of law has impacted the rights of an injured worker. If so, the Commission can make a decision that overrules the decision of the Administrative Law Judge. Filing a Claim for Compensation and appealing a Columbia workers’ compensation decision can be a lengthy and complex process. It may benefit an injured or ill worker to seek legal help immediately.
Receiving a denial for workers’ compensation benefits after suffering a workplace injury or illness can be a demoralizing experience. You are relying on these payments to cover the costs of medical care as well as to provide income insurance.
Fortunately, the receipt of a denial is not the end of a claim. You always have the option to request that the Missouri Division of Workers’ Compensation and the Labor and Industrial Relations Commission hear the merits of your Claim for Compensation. Whether the insurance company’s denial alleges a failure to file a claim on time, that the condition was not related to work, or that the injury is not sufficiently severe, you can ask an Administrative Law Judge or the Labor and Industrial Relations Commission to reconsider the claim. There is a limited time after your injury to act. Take a step toward appealing your workers’ compensation decision in Columbia by calling today.