Understanding Partial Denials of Your Worker's Compensation Claim

If you were injured at work, filing for workers' compensation can be an overwhelming process. Not only do you have to file the compensation claim with your employer's insurance company, but you also run the risk of having your claim denied. What many people don't realize, though, is that they can only part of your claim. Here's what you need to know about partial denials for your worker's compensation claim.

What Kinds of Partial Denials Are There?

There are a few different types of partial claim denials, and understanding what they are can help you to be better prepared for your claim process.

For example, you may receive a denial that's focused solely on the charges from a specific provider. If the provider wasn't approved by the workers' compensation insurance board or your company, they may deny those charges on the grounds of a lacking approval. 

In other cases, you may receive a denial of specific treatments. If the insurance company believes that those treatments were related to other injuries, such as a pre-existing injury or one that was not work-related, they may deny payment for the specific treatments.

Finally, the insurance company may deny everything related to a specific injury. If the insurance company believes that the injury in question wasn't work-related or was a pre-existing injury, they may refuse to pay for all of the expenses related to that injury.

What Can You Do About Those Denials?

You may think that there's nothing you can do about a partial denial of your workers' compensation claim. You might think that the partial payment you receive is the best that you can do. The truth is that you may, in fact, be able to contest that denial.

In order to contest the denial, you'll need to have your attorney find out why the claim was denied to begin with. Once you know why it was denied, you need to talk with your attorney about building a case to prove the denial's assumptions incorrect.

For example, if the insurance company denies a claim because they believe the injury to be a pre-existing condition, or because they believe a treatment was not related to the work-related injury, your attorney can help you show documentation that details the relevance of the treatment or the actual timing of the injury. It may mean seeking testimony from medical professionals or showing the statements from your healthcare provider and the evidence from when you sought treatment.