The Top Reasons Workers’ Comp Claims Are Denied in Lexington

Has your workers’ compensation claim been denied after you were injured on the job in Lexington? If so, you may be wondering about the reasons for the denial and whether you can do anything about it.

At Morgan, Collins, Yeast & Salyer, we understand the common reasons that workers’ compensation claims are denied. Let our dedicated attorneys help you appeal a disputed claim.

If your claim has been denied, don’t take “No” for an answer. Kentucky Courage means standing up for your rights when the going gets tough. Our Kentucky Courage attorneys are honored to help injured Kentuckians seek the full benefits available to help them recover from serious injuries.

You Missed a Deadline

Employees are required to notify their employers of work-related injuries or illnesses as soon as practical. If you failed to notify your employer in a timely manner, the workers’ comp insurance administrator may have grounds to deny your claim.

You may also be barred from recovering workers’ comp benefits if you miss any of the following deadlines for filing a workers’ comp claim:

• Filing a claim for an injury – For most work-related injuries, you have two years to file a workers’ comp claim. This two-year time limit extends from the date of your injury, or if you have already received benefits, the day of your last benefits payment.
• Filing a claim for a death – If your loved one died from a work-related condition, you generally have two years from the date of their death to file a claim for workers’ compensation death benefits. If their fatal condition was the result of an occupational disease, you have three years from the date of their death.
• Filing a claim for exposure to HIV – If your condition is the result of work-related exposure to the human immunodeficiency virus (HIV), you have five years from the date of exposure to file.
• Filing a claim for cumulative trauma– If your condition is the result of work-related cumulative trauma, such as repetitive motion strain, you generally have two years to file. However, if you do not recognize immediately that your injury or illness is work-related, you have two years from the date of discovery, as long as you file no more than five years after your last exposure.
• Filing a claim for an occupational disease – If your condition is the result of an occupational disease, such as Black Lung, you have three years from the date of your last exposure to file. This time limit can be extended if you do not immediately discover that your condition is work-related, as long as you file within five years of exposure. If your condition is from work-related radiation or asbestos exposure, you have 20 years from the date of your last exposure to file.

Your Condition Doesn’t Meet State Guidelines

Nearly all physical work-related injuries are covered under Kentucky workers’ compensation guidelines. However, when it comes to certain types of invisible injuries, claim denials are more common.

For example, if you develop a medical condition as the result of work-related cumulative trauma, your employer or the insurance company may argue your condition is actually a result of the natural aging process and should not be covered. In this instance, you may need to provide evidence from a medical professional to show your condition is work-related. Our attorneys can help you get a referral to a medical professional who can examine you and offer an opinion about whether your condition is related to your work.

Claims for benefits for psychological injuries can be challenging. Your psychological injury may be denied unless you can prove your psychological condition is directly related to a physical work injury.

Your Condition Is Not Work-Related

Your injury would almost certainly be considered work-related if you were injured while performing your usual job duties at the workplace during normal work hours. However, if you were injured under other circumstances, the employer or insurance administrator may dispute the claim.

For example, your employer or their insurance provider may question whether your condition is work-related if:

• You were injured during unpaid break time
• You were injured at a company non-work event
• You were injured while at a non-work location
• You were injured in the workplace parking lot
• You were injured while breaking company policy
• Your work injury aggravated a pre-existing condition

You may still be entitled to workers’ comp benefits, depending on the circumstances of the injury. But you may need help from an experienced attorney to prove you are entitled to benefits.

You Filed the Claim After You Left Your Job

If you quit your job after sustaining a work-related injury, it may be more difficult to get workers’ comp benefits, even if you are otherwise eligible. Insurance providers are often skeptical when workers file claims after quitting. You will likely need proof that you were injured while working for your previous employer.

If no one else saw your injury occur and you didn’t seek treatment right away, your claim is more likely to be denied. This is especially true if you failed to notify your employer in a timely fashion.

The rules for claiming workers’ comp after leaving a job can be complicated. It’s best to work with a knowledgeable Lexington workers’ comp attorney if you receive a claim denial letter.

How to Appeal a Workers’ Comp Denial in Lexington

If your Lexington workers’ comp claim was denied, you have the right to appeal the decision. The steps involved in filing an appeal include:

• Reviewing your notice of denial – The official denial letter you receive from the Kentucky Department of Workers’ Claims (DWC) should contain the reason for the denial and instructions for filing an appeal.
• Requesting a Benefits Review Conference – You can request an informal Benefits Review Conference with the insurance company to discuss the denial and a possible settlement. Your attorney can attend the conference with you and advocate for you.
• Requesting a hearing with an administrative law judge (ALJ) – If your claim is still denied, you can request a formal hearing before an ALJ, who will make a decision within 60 days of the hearing. A hearing before an administrative law judge is a legal proceeding. You should have a workers’ compensation lawyer representing you at the hearing.
• Filing a Petition for Reconsideration – If the judge denies your claim, you have 14 days from the date of the decision to file a petition asking the judge to reconsider.
• Requesting an appeal with the Workers’ Compensation Board – You can request an appeal with the Workers’ Compensation Board within 30 days of the judge’s decision to deny your claim.
• Requesting an appeal with the Kentucky Court of Appeals – If your claim is denied by the Workers’ Compensation Board, you can appeal your case to the Kentucky Court of Appeals.

Are You Looking for Assistance for a Workers’ Comp Claim in Lexington?

The experienced Lexington lawyers of Morgan, Collins, Yeast & Salyer have years of experience handling all types of workers’ compensation claims, including pursuing appeals when insurers have unfairly denied the claims. If you have a disputed work injury claim, seek the help of a qualified workers’ compensation lawyers. Call us at (877) 809-5352, or contact us online to get started with your free initial consultation.

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