Any San Rafael Workers’ Compensation Attorney can tell you how heartbreaking it is when someone is hurt or has an accident and their medical requests are denied. You can leave you feeling broken down and hopeless, as this is the time when workers compensation should be a factor. The program exists for this exact reason, so why are you not covered? And what happens now that you’ve been denied?
Facing paying off your own medical bills and leave you in a state of shock. Rather than accepting the judgment, you can fight it! The first “no” isn’t the end of the story as you can fight to get your claim approved by taking it to court. This is really the best option you have in hiring a workers’ compensation attorney will walk you through the process.
Why You Were Denied
The first thing you should look at is understanding why you were denied in the first place. Knowing that you should always file a claim if you’ve been injured at work, it might seem rare that someone who has been going through this can be denied workers compensation. But it happens and it’s a detriment to that person and their family does not only losing work, but they might also have piling medical bills they cannot afford to pay.
So, the first step in battling the denial and understanding why it happened. The answer might be simple. To receive workers’ compensation benefits, usually your employer’s insurance company has a network of doctors already approved. This means that if you are denied, it might not be because of the basis of your injury, but that you went to see your own doctor who is unauthorized to make the decision for the insurance company.
Still, there are many other unanswered causes. You still be denied even if you went through the insurance company’s network. They don’t make it easy for you to receive benefits or for your medical bills to be paid off. These are very stingy companies that have a reputation for denying people the help that they need. They may not deny the entire process either. In many cases, they can deny parts of the medical treatment that you need covered.
Insurance companies also take the role of doctors. They will tell you whether they think the recommended treatment is necessary or not. If they think you don’t need the procedure or treatment, they’ll deny you straightaway. They know they can get away with it because people end up accepting the first denial and walking away without protest. The bottom line for them is profit and it’s easy to understand why and how they can just deny your claim.
You Can Fight Back
Many workers’ compensation claims are denied offhand and sometimes have no reason other than the insurance company doesn’t want to pay for it. Any experienced workers’ compensation attorney can tell you that there are many people who sustained massive injuries, including broken bones and brain injuries, and were still denied benefits. In one particular case, someone was crushed at work bad enough to cause a severe brain injury and many balance problems.
In this case, the doctor wanted the person to go through physical therapy to help correct the balance issues as a result of their injury. Yet, insurance company denied them. Even after their balance issues cause them to fall several more times, the doctor again said the only way to correct the balance issues was physical therapy. The insurance company did another review and again decided not to pay for the physical therapy they needed.
This is one instance in which the person involved has no other choice but to take the insurance company to court to fight for their rights. This is the only thing you can do if you’ve been denied workers compensation. You have to ask the court to do what is called an “untimely review” so a judge can look at your case and overrule the insurance company. Judge can make the insurance company pay for the treatment you need to help you recover and get you back to work.
Other Issues with Insurance Companies
In a lot of cases, the insurance company will work against your best interest to find any way to deny you. You often don’t know who they’re sending the claims to, how much they’re paying that person to deny as many claims as possible, or even how much information insurance companies are sending them to do an honest review. Many cases have been denied because the insurance company only sent some information in the case for review.
In one case, the insurance company sent medical records to a doctor who wasn’t even in the same state in which the injured person lived. How is that a good way to determine approval? They not only send part of the information, but they send it to a doctor to review several states away. This is another good reason why you should fight your denial. It shows that the insurance company didn’t offer a proper review, a judge can still decide in your favor.
This brings up another important point. When you’re making a claim, write out everything that happened in very clear detail. Yes, the insurance company may break apart and only send to the reviewer what they feel is necessary. That will still boat in your favor later on if the case is taken to court. You provided detailed records, but the insurance company acted in a way to prevent the full understanding of the case from being seen.
You need powerful representation to fight for you and your interests. Only by hiring a workers’ compensation attorney will you be able to fight back and win the benefits you deserve. Getting injured on the job can ruin your life, so partner with an attorney who will help you fight the system designed to deny you.