Common Reasons Why an Employer May Dispute a Workers' Compensation Claim
Iowa's employers must carry workers' compensation insurance policy that pays out benefits to injured workers who qualify for compensation. If a worker files a valid, timely claim for benefits, the employer and its insurance company should pay out benefits to the worker. In some cases, an employer may dispute a workers' compensation claim. Unfortunately, not all of these employers have a legitimate or fair reason to dispute the claim. Common reasons that an employer might dispute a claim include costs of insurance, location of the injury, and lack of visibility of the injury.Costs of Insurance
One of the major motivations for a denial is often money. Your employer may be more focused on their profits, not your recovery. If there are many workers comp claims being filed, the insurance company may raise the costs of their premiums, meaning your employer pays more for the insurance they must carry. Because they're focused on keeping those numbers to a minimum, they may try to deny your workers comp claim. They want to keep their costs low, so they'll try to put the expenses on you.Disputes on Location of Accident
In other dispute cases, your employer may not believe that your accident happened at work. This dispute often arises when workers don't seek medical care right away. Your employer may use this delay to their advantage, claiming that you could have been injured somewhere else, not at work. That's why you'll need to seek medical treatment immediately after an accident, even if you feel fine. For example, you may have slipped and fell, but you just feel a little bruised. Later, your back hurts so much that you can't work. If you waited to see a doctor, your employer may claim you could have been injured somewhere else.Visibility of Injuries
Some injuries are less obvious and clear-cut than others. For example, it may be clear that you were injured if your arm was caught in a machine, but what about repetitive-motion injuries or work-related illnesses? Less-visible illnesses can be harder to prove, which may lead to a dispute. Your employer might question whether you were truly injured. Often, that means you'll need to seek out more exams and proof from your doctor. These tests can strengthen your claim and show your employer the severity of your injuries.
Resolving a Workers' Compensation Dispute
Sadly, not every injured worker gets the compensation they need right away. Your employer or his or her workers' comp insurance provider might dispute information regarding your injury. You’ll need to know how to handle an Iowa workers' comp dispute to obtain your benefits soon. There are a few steps you can take with your attorney to appeal your claim.Informal Meetings
Once you’ve filed your claim, you should receive a letter approving or denying your claim. A denial is unfortunate, but it’s not the end of your chances for work comp benefits. Hang onto your workers' compensation dispute letter, as it will provide the reason for denying your benefits, and this can help you during the appeals process. First, retain the help of a workers' comp attorney. Then, discuss your work comp situation with your employer and the insurance provider together. In some cases, your attorney might be able to negotiate a settlement with them before taking your case further. Be sure to review your denial reason before scheduling a meeting with your employer. You’ll need to know what factors led to your denial, which can range from a missed deadline to a lack of medical evidence. This gives you a chance to review your claim and gather additional evidence. Unfortunately, your employer and the insurance provider might not budge on their decision. In this case, you’ll need to appeal your claim to the Iowa Workers Compensation Commission.
Handling Workers’ Compensation Disputes at the State Commission Level
The Iowa Division of Workers’ Compensation maintains files on all claims and can help all parties understand their rights and options. When an employee and an employer cannot resolve their disagreement, the office can suggest ways to seek a resolution. A compliance administrator can evaluate the case. While compliance administrators cannot represent the interest of either side, they can and do provide information on state law, the rights of both parties, and state procedures. They can also offer:- Mediation services
- Alternate medical care
- Health services dispute resolution
This can be a good place to find information and provide a framework for resolution short of the formal process. Many cases are resolved in this manner and avoid the stress of a formal dispute.
Your Workers' Comp Hearing
When your employer or insurance provider continues to deny you the compensation you deserve, you and your attorney will need to schedule a workers' compensation hearing with the Iowa Workers' Compensation Commissioner, which will oversee your appeal. This is known as a contested case proceeding. In a contested case proceeding, the commissioner or a commissioner’s deputy will hold a hearing. At that time, both sides will offer their version of events and provide evidence to support their claims.
Here, you’ll need to bring all the evidence needed for your appeal. For example, you might bring eyewitness reports that your accident happened while working; or you might need further medical exam results to show the severity of your injuries and the impact they have had on your life. In these situations, the burden of proof is on the injured employee to prove that he is entitled to the benefits sought. You and your lawyer will appeal the denial at the hearing. Your lawyer will present the evidence before the commissioner and your employer. Once this is completed, the commissioner will either approve the appeal or deny your workers' comp benefits for a second time.
Get Legal Help with an Appeal
When you’re injured, your workers' comp benefits should help you recover as soon as possible. Unfortunately, the insurance company might not be so willing to approve your claim, leaving you stuck with mounting bills and lost wages. When this happens, you’ll need to know how to handle an Iowa workers' compensation dispute to get your claim appealed. The workers' compensation lawyers at Pothitakis Law Firm, PC can help dispute workers' compensation claim denials. They’ll review your case, prepare your appeal, and represent you before the Iowa Workers Compensation Commission. Struggling with a denial that left you without compensation? Get on track with one of our free consultations. Claim yours by calling (866) 753-4692 or by filling out the online form below.
