If you’ve suffered a work-related injury or illness that requires extensive medical treatment, you’re likely concerned about the financial implications. Workers’ compensation is designed to provide the necessary benefits to cover your medical bills and ensure you receive the quality treatment you need. However, what happens if your workers’ comp claim is denied? This article explores the options available to you when faced with a denied claim and how it can impact your medical bills.
What to Do if Your Workers’ Comp Is Denied
If your claim for workers’ compensation has been denied, don’t lose hope. You still have options to pursue the benefits you are entitled to. Here’s what you should do:
Contact a Lawyer
Dealing with a denied claim can be frustrating and overwhelming, especially while trying to recover from your injury. Consulting with an experienced attorney who specializes in workers’ compensation laws and regulations can significantly increase your chances of winning your case.
Refile Your Workers’ Comp Claim
If your claim was denied due to an error or incomplete information, refiling the claim is often the best course of action. Your attorney can help you correct any inaccuracies and ensure you have the best chance of being approved upon resubmission.
Request a Hearing
If you believe that your benefits have been unfairly denied, you have the right to appeal the decision by filing a Request for Hearing form with the Workers’ Compensation Board. It is crucial to submit your request within 60 days of the denial to be considered. Your attorney will support you during the hearing, presenting your case and providing additional evidence.
Submit a New Claim
In some cases, a complete overhaul of your claim may be necessary. If your initial paperwork contains errors or lacks sufficient details, or if you have received a poorly conducted independent medical examination (IME), submitting a new claim may improve your chances of approval.
Why Workers’ Compensation Claims Get Denied
Unfortunately, thousands of workers face unfair claim denials every year. The most common reasons for denial include:
- Insurance companies hoping that claimants won’t appeal
- Employers questioning the legitimacy of the injury and claim
- Filing mistakes by the workers themselves
- Independent medical examination reports disputing the injury’s authenticity or associating it with pre-existing conditions
If your workers’ compensation claim is denied, it’s important not to give up. You have the right to appeal the decision to the Oregon Workers’ Compensation Board. Our experienced lawyers at RGMR have helped numerous injured workers appeal denied claims and obtain the compensation they deserve.
What to Do While Waiting for Your Claim to Get Reapproved
If your claim was initially denied and you have submitted a new claim for reconsideration, it is crucial to continue seeking treatment for your injury. Not only does receiving treatment improve your chances of full recovery, but it also demonstrates your commitment to healing to the Workers’ Compensation Board. At RGMR, we can help you find honest, high-quality medical providers who can treat your injury while you wait for your workers’ comp claim to be accepted.
What Medical Bills Are Covered by Workers’ Comp?
In Oregon, workers’ compensation insurance covers medical treatment and lost wages for work-related injuries or illnesses. Accepted claims generally cover the following medical expenses:
- Emergency room care
- Hospital visits
- Doctor’s appointments
- Rehabilitation and therapy
- X-rays and MRIs
Each workers’ comp case is unique, and coverage may vary. If you believe you have been treated unfairly or had your medical treatment denied, our experienced lawyers at RGMR can guide you through the process and determine which doctors and treatments will be covered.
How to Improve the Chances of Your Claim Being Approved
Collaborating with a qualified workers’ compensation and personal injury attorney can significantly increase your chances of approval. At RGMR, we have a comprehensive understanding of Oregon’s legal system and can fight for your rights. Here are a few tips to consider:
Avoid Filing Mistakes
One of the most common reasons for claim denials is mistakes made during the filing process. Ensure that you include all relevant details, follow your doctor’s advice, and advocate for yourself throughout the claims process. Working with an experienced attorney can help improve your chances.
Prepare for Your Doctor’s Evaluation
An unfair independent medical examination (IME) report can negatively impact your claim approval chances. Preparing for your evaluation and actively advocating for yourself during the appointment can help mitigate this risk.
Exploring Other Options if Workers’ Comp Is Denied
If your claims continue to be denied, there are alternative avenues to explore for financing your treatment, such as Medicaid, Medicare, or group health insurance.
Facing Expensive Medical Bills for Your Injury? RGMR Can Help!
If you’re struggling with a work-related injury or illness and feel overwhelmed by a denied workers’ compensation claim, you don’t have to face it alone. The attorneys at Ransom, Gilbertson, Martin, & Ratliff, LLP are here to support you and build a strong case to secure the benefits you deserve.
With over 70 years of combined experience and a deep understanding of Oregon workers’ comp law, we are prepared to fight for your rights every step of the way. We take the time to understand your unique situation, and you won’t have to pay us unless we win your case.
Contact us today for a free consultation.