Workers’ Compensation Denial Lawyers in Springfield, MO

Has Your Claim Been Denied in Missouri?

When an employee is hurt on the job or diagnosed with a work-related illness, the employer and its workers' compensation insurer must pay the cost of any medical care and wage benefits.

If your employer or insurer makes it difficult to collect benefits in this situation, you need an attorney who knows Missouri workers' compensation law inside and out. With nearly 50 years of professional experience shared by our attorneys helping employees in these matters, our savvy legal team at Webster & Carlton can help. 

Why Do Claims Get Denied?

Denials of workers' compensation claims are more common than one might expect. According to some studies, about one in every seven workers' compensation claims is initially denied. There are various reasons for this high rate of denial. 

An employer's insurance company could deny an injured worker's claim for many reasons. For example, your insurer and employer could argue that:

• Your accident did not happen at work.
• Your injury is a result of a pre-existing condition.
• What happened was not an accident.
• You failed to report your injury or illness promptly.
• Your conduct contributed to the injury.

Furthermore, certain types of injuries are more challenging to prove as work-related, such as repetitive stress injuries or conditions that develop over time.

Even if the insurer initially approved your claim, sometimes it will stop payment if it believes:

• You no longer need treatment for an injury.
• You have not adhered to the medical plan or have missed appointments.
• Your injury is a result of a pre-existing condition.

Claims also get denied due to incomplete or incorrect paperwork, a common issue when dealing with complex workers' compensation forms. In any of these situations, the insurance companies may refute the claim, asserting the injury is due to non-work-related factors. 

What Happens When an Insurance Company Objects to Your Medical Treatment?

While many workers’ comp claims are authorized when you have followed the correct steps, sometimes an insurance company objects to medical care. If your workers’ comp insurer has opposed the treatment you and your healthcare provider believe is necessary, you need to understand what steps to take next: 

Determine the Reason for the Objection

If your insurance company discontinues your medical treatment or outright refuses to provide medical treatment, you must determine why. 

Some common reasons include: 

• Your case has been denied. Your employer may dispute that your injuries are valid or occurred on the job.
• Your employer or insurer believes you have improved to the point where you no longer need care and can perhaps even return to work.
• The insurer feels that you are not complying with medical instructions, such as not following your doctor’s directions, not attending appointments, etc.

In such cases, you must request a written explanation from the insurance company as to why they have objected to your medical treatment. From there, you can take the following steps.

Independent Medical Examinations

Sometimes, the fact that your insurance company has denied your medical care is a misunderstanding or an error, and simply discussing the problem can remedy it. However, if you and your insurer cannot agree, the next step may be undergoing an independent medical examination (IME). During an IME, an impartial doctor will assess you and provide a second opinion about your condition and needed treatment.

Appealing a Denied Workers' Compensation Claim

Facing a denied workers' compensation claim can be both frustrating and stressful. However, you have the right to appeal. Our seasoned Springfield, MO attorneys at Webster & Carlton are here to assist you through the appeals process and advocate for the benefits you deserve.

When appealing a denied workers' compensation claim, it's essential to:

• Examine the denial letter thoroughly to clearly understand why your claim was rejected.
• Collect any further supporting material or evidence to help support your claim.
• Send in a formal appeal within the allotted period.
• Participate in all of the required hearings and provide testimony if you have to
• Work with a skilled attorney who can advocate on your behalf and present a strong case

Don't give up if your workers' compensation claim has been denied. Contact Webster & Carlton as soon as possible to set up a consultation and learn how we can help you appeal the decision.

How Long Do I Have To Appeal A Denied Workers’ Comp Claim?

In Missouri, you must take immediate action to protect your rights if your workers' compensation claim has been rejected. After obtaining the refusal, you have 20 days to submit an application to the Labor and Industrial Relations Commission (Labor Commission) for review. If you miss this deadline, it may be very difficult for you to get the benefits you are entitled to.

It's important to remember that the appeals process involves strict deadlines and detailed paperwork. Working with qualified workers’ comp denial lawyers in Springfield ensures that all required documents are filed correctly and promptly, enhancing your chances of a favorable outcome.

If you've received a denial notice for your workers’ compensation claim, don't wait to seek legal assistance. Get in touch with Webster & Carlton by calling (417) 545-3775 and request a consultation.

Reserve your no-fee consultation with a Springfield workers’ compensation claim denial attorney by contacting us online or at (417) 545-3775.