Workers’ compensation provides essential financial and medical support to employees injured on the job. However, receiving these benefits isn’t always straightforward. Louisiana workers’ compensation claims can be denied for a variety of reasons. A denial can leave injured workers feeling uncertain about their future and unsure of how to proceed.
If your workers’ compensation claim has been denied in Louisiana, it’s important to understand your rights and the steps you can take to appeal the decision. In this guide, we’ll walk you through what to do if your workers’ comp claim is denied and how a New Orleans workers’ compensation lawyer at Ascend Disability can help.
Why Was My Workers’ Compensation Claim Denied?
Before diving into the appeals process, it’s crucial to understand why your claim might have been denied. Workers’ compensation claims in Louisiana can be rejected for several reasons, including:
- Lack of Sufficient Medical Evidence: One of the most common reasons for a workers’ comp denial is the lack of adequate medical documentation to prove that your injury is work-related or serious enough to require benefits.
- Missing or Incomplete Paperwork: Workers’ compensation claims require detailed documentation. If you failed to submit all the required forms or the information was incomplete, the insurance company might deny your claim.
- Disputed Work-Related Injury: Your employer or their insurance company may dispute the claim, arguing that the injury did not occur on the job or that your job duties did not cause the injury.
- Late Filing: Louisiana has strict deadlines for filing workers’ compensation claims. If you did not report your injury within the state’s reporting time frame or file your claim on time, it may be denied.
- Pre-existing Conditions: If you had a pre-existing condition, the insurer might argue that your current medical issues were not caused by your job, leading to a denial.
- No Witnesses: If no one witnessed your injury and there is no corroborating evidence, the insurance company might deny your claim on the basis that your story is unverified.
Understanding the reason for your denial is the first step toward crafting a successful appeal. Review the denial letter carefully, as it will outline the insurance company’s reasoning and any further steps you can take.
What to Do If Your Workers’ Comp Claim is Denied
A workers’ compensation claim denial is not the end of the road. In Louisiana, you have the right to appeal the decision and fight for the benefits you deserve. Here’s what you can do after receiving a denial.
Review the Denial Notice
The denial notice you receive from the workers’ compensation insurance company will explain why your claim was denied. Carefully review this letter to understand the specific reasons for the denial, as this will guide your next steps. If the denial is based on missing documentation or clerical errors, you may be able to rectify the issue quickly.
Contact an Experienced Workers’ Compensation Lawyer
Hiring a workers’ compensation lawyer is one of the most critical steps you can take after receiving a denial. An experienced attorney at Ascend Disability can help you review your denial, gather additional evidence, and represent you in the appeals process. Your lawyer will also be familiar with Louisiana workers’ compensation laws and can advise you on how to proceed based on the specific facts of your case.
File a Disputed Claim for Compensation
If your workers’ compensation claim is denied, you have the option to file a Disputed Claim for Compensation (Form LWC-WC-1008) with the Louisiana Office of Workers’ Compensation (OWC). This is essentially the beginning of the formal appeals process.
You have one year from the date of your injury to file a disputed claim. If your injury was not immediately evident and you only became aware of it later, you have one year from the date you knew or should have known of the injury to file your appeal.
Attend Mediation
After filing your disputed claim, the OWC may schedule a mediation session to resolve the issue without the need for a formal hearing. Mediation is a less formal, less adversarial process where a neutral mediator helps both parties (you and the insurance company) attempt to reach a settlement.
While mediation can be effective, it’s important to have legal representation to ensure that any settlement you agree to is fair and adequately compensates you for your injuries. An experienced attorney can negotiate on your behalf and guide you through the mediation process.
Prepare for a Formal Hearing
If mediation fails to resolve the dispute, your case will proceed to a formal hearing before a workers’ compensation judge. This hearing is similar to a trial, where both sides present evidence, call witnesses, and argue their case.
At the hearing, your lawyer will need to present medical records, witness testimony, and any other relevant evidence to prove that your injury is work-related and that you are entitled to benefits. The workers’ compensation judge will then make a ruling on your case.
Your lawyer will play an essential role during the hearing by:
- Preparing and presenting your case: Gathering medical evidence, calling expert witnesses, and preparing arguments to refute the insurance company’s defense.
- Cross-examining the insurance company’s witnesses: Challenging the validity of their arguments, especially if they are claiming your injury was not work-related.
- Protecting your rights: Workers’ compensation laws can be complicated, and your attorney will protect your rights throughout the process.
Appeal the Judge’s Decision
If the workers’ compensation judge rules against you, don’t lose hope. You have the right to appeal the decision to the Louisiana Court of Appeal. This appeal must be filed within 30 days of the judge’s decision.
At this stage, it’s critical to have a skilled lawyer by your side. An appeal is not a new trial; rather, the court will review the record from the original hearing to determine if any legal errors were made. Your attorney will file legal briefs, outlining why the judge’s decision should be overturned based on the evidence and applicable laws.
How a Lawyer Can Help With Workers’ Compensation Appeals
Navigating a workers’ compensation denial and appeal in Louisiana can be overwhelming, especially when you are recovering from an injury. This is where a lawyer from Ascend Disability can make a significant difference in your case. Here’s how a skilled attorney can help:
Investigating Your Claim and Filing Paperwork
Your lawyer will investigate why your claim was denied and work to collect additional evidence that supports your case, such as medical records, expert testimony, and witness statements.
A workers’ compensation lawyer will ensure that all forms, deadlines, and legal procedures are followed, reducing the risk of another denial due to technical errors.
Negotiating with the Insurance Company
Even after a denial, there may be opportunities to negotiate a settlement with the insurance company. Your attorney can handle these negotiations and ensure that any settlement offer is fair and in your best interest.
Representing You at Hearings and Appeals
Whether your case proceeds to mediation, a formal hearing, or an appeal, your lawyer will provide the legal representation needed to give you the best chance of a successful outcome.
Maximizing Your Benefits
A knowledgeable attorney understands the full range of benefits available under Louisiana’s workers’ compensation laws, including wage replacement, medical care, and vocational rehabilitation. They can help you secure the maximum compensation available for your case.
Contact a Louisiana Workers’ Compensation Lawyer Today
If your workers’ compensation claim has been denied in Louisiana, it’s essential to take action quickly to protect your rights. While the process can be complex and frustrating, you don’t have to face it alone.
Ascend Disability in New Orleans is dedicated to helping injured workers navigate the workers’ compensation system and appeal denied claims. With the right legal guidance, you can increase your chances of securing the benefits you deserve. Contact us today to schedule a consultation and get the support you need to move forward with your claim.
