Determining the Validity of a Columbia Workers’ Compensation Claim

Workers’ compensation insurance is a primary benefit that most workers in Columbia enjoy as a matter of law. In fact, all workplaces with at least five employees and all construction companies must obtain this protection for all employees.

However, the mere fact that a company has workers’ compensation insurance does not mean that a workplace injury will automatically result in benefits. State law requires claimants to prove that their injury occurred as the result of a workplace accident or condition. In addition, workers must also provide their employers with proper notice of the incident to collect benefits.

Determining the validity of a Columbia workers’ compensation claim is a vital first step in collecting benefits. For people who have received a denial after filing a claim, contacting a dedicated workers’ compensation attorney could result in a positive outcome with insurance adjusters.

Demonstrating a Workplace Connection

It is a core tenant of state workers’ compensation law that an employee can only collect payments if they are able to prove that their condition arose as a consequence of doing their job. This is a more complex concept than it at first appears.

On the one hand, Missouri Revised Statutes §287.020 defines a workplace accident in Columbia as an unexpected traumatic event or unexpected strain that occurs during a single work shift. This means that a worker must be able to trace their injury to a specific incident that occurred while on the clock and while doing their work duties. Insurance companies may deny a claim if they believe that the injury occurred while off duty, during a break, or during a commute.

The same concept applies to claims that center around occupational diseases. Missouri Revised Statutes §287.067 defines this concept as an identifiable disease arising out of doing one’s work duties. Cancers, lung problems, and even skin conditions may all be the consequence of exposure to toxic chemicals and other harsh substances. If an insurance company denies a claim because of a lack of a workplace connection, it falls to an employee to be able to demonstrate the validity of their benefits claim.

Claims that Fail Because of an Inability to Follow Procedure

It is true that most workers’ compensation claims fail because of a lack of medical evidence. However, an insurance company is just as able to deny a claim because of a lack of information provided by the employee.

Under Missouri Revised Statutes §287.420, injured employees in Columbia have a duty to provide written notice to their employers within 30 days of the incident that left them unable to work. A failure to provide this notice gives insurance companies justification to deny a claim.

It is also vital that injured workers follow up with all necessary medical care. The validity of an employee benefits claim depends on a medical professional’s opinion as to the extent of an injury and whether an injured worker would benefit from additional treatment. A failure to attend these appointments may cast doubt on the severity of a condition or the need to receive additional benefits.

Determining the Validity of a Workers’ Compensation Claim in Columbia is Vital to Receiving Proper Benefits 

If you have received a denial in your claim for workers’ compensation benefits, or if an offered payment package is not enough to fulfill your needs, you need to understand why. The law in Columbia requires most employers to provide insurance coverage, but insurance companies may still deny a claim for a collection of reasons.

Among these reasons are a lack of a connection to doing one’s job, an inability to properly document the condition, or an employee’s failure to cooperate with the claims process as required by law. A denial letter must state the insurance company’s justification for the denial of benefits. Only by understanding the essential elements of a valid workers’ comp claim can a worker pursue an effective appeal. As a result, determining the validity of a Columbia workers’ compensation claim requires an evaluation of the medical evidence in the case, as well as examining the connection to time spent on the job. Call today to learn more.

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