What If My Workers’ Compensation
Claim is Denied?
April 26, 2022
Workplace accidents can happen for any number of reasons, and when they do, it’s reassuring to know your expenses will be covered by worker’s compensation benefits. Workers’ comp insurance is required for the vast majority of Oregon employers and ensures that costs like medical bills and lost wages are covered by their plan. While many of these claims are straightforward, others can be more complicated, and you may be denied coverage. When this happens, you have every right to appeal this decision. If you’d like help with filing or appealing a recent workers’ comp claim denial, give us a call at the Law Office of Michael J. Orlando to discuss your options. From our offices in Beaverton, Oregon, we’re able to serve any injured worker throughout the State of Oregon.
Reasons a Workers’ Compensation
Claim May Be Denied
If your claim was rejected, you must first determine the reason for denial. You may receive a workers’ compensation denial for a simple filing error such as submitting your claim after the statute of limitations has expired or failing to include sufficient evidence. In Oregon, you must report all injuries to your employer within 90 days of the accident, or if you’re suffering an illness or medical condition linked to your job duties, you have one year to submit a claim from the time you are first diagnosed with an occupational-related disease. You may also be denied if your employer disputes your request, claiming the injury or condition was either preexisting or didn’t occur at work. Lastly, some claims are denied if there were no witnesses to the accident that could corroborate your story.
Notice of Controversion
One specific type of (a non-Oregon) workers' compensation denial is called a Notice of Controversion of Right to Compensation (also called an LS-207 form). This is only for those who have worked for the U.S. military outside of the country under the Defense Base Act (DBA). These workers are entitled to compensation but will be covered under different provisions than other Oregon employees. A Notice of Controversion means your employer on the base is disputing your claim, and you’ll likely need a workers’ compensation attorney with experience working within the DBA to appeal.
Appealing the Decision
If you want to file an appeal to a workers’ compensation claim denial, you must appeal it within 60 days of its issuance date. The denials will contain all-cap, bold-faced language that will provide you with several methods to timely appeal it. This is the point you want to retain an attorney because the insurance companies all have attorneys working behind the scenes that you will never know about until the denial is formally appealed.
Accepting a Settlement
When you finally accept a workers’ compensation settlement offer, you should only do so after reviewing it with your attorney to ensure it meets all of your needs and will cover all of your expenses. It’s up to you whether or not to accept the offer—not your employer. Consider the long-term needs associated with your injury or disability and how likely the settlement amount will cover it all. You may wish to accept the offer to reduce stress and give you peace of mind knowing your claims process is over, but you may also be missing out on much-needed money if your condition worsens. The best way to address this is by discussing your options thoroughly with your attorney and doctor.
How Legal Counsel Can Help
Getting injured on the job can be the beginning of a long and stressful road. While you’re focusing on your recovery and providing for your family, the last thing you want to worry about is going back and forth with a claims adjuster. By calling the Law Office of Michael J. Orlando in Beaverton, Oregon, you’ll find comfort knowing you’re working with an attorney who only focuses on workers’ compensation cases and will be your advocate for pursuing the recompense you rightly deserve.