Todd is a construction worker who specializes in laying down concrete foundations for new apartment buildings in Washington D.C.
He wakes up on an early morning and it’s just a normal day working at the construction site. Todd chooses to climb up a ladder that unfortunately is not up to safety standards, and it’s also slightly wet and humid outside.
All of a sudden, Todd has fallen from a ladder and he breaks both of his legs with the worst pain he has ever felt in his life. Immediately, he gets transported to the ER with many doctors to help him with immediate medical care.
Now, there are more medical bills Todd has that are more expensive than a brand new Tesla and he is not expected to return to work for a year, according to his doctors.
Todd might be thinking of ways he can possibly support himself financially, and his friends are encouraging him to file a workers’ compensation claim. After filing the claim and waiting months, while guiding through the red tape, his claim gets denied.
It now seems impossible for him to get his life back on track, especially after the time and effort it took for him to file a workers’ compensation claim. But, Todd may not realize that he might have filed the claim incorrectly.
As dire as Todd’s situation is, unfortunately, these scenarios are now more common than ever due to the broken workers’ compensation system in America.
On the other hand, if you file a claim the correct way, a workers’ compensation claim can help you pay for your medical bills and cover your wages when you are not working.
But there are a number of different steps to take when your claim gets denied that can be more beneficial than you may think. So what are these steps to take? Let’s find out.
Immediate Actions to Take After Your Claim Gets Denied
If your claim gets denied, you will receive a letter that formally denies your claim. This will likely result in much anger, but there are a number of immediate steps you should take.
1. File An Application For Adjudication To The DWAC
The first action to take is to file an Application for Adjudication of Claim form with supporting documents to the DWC (Division of Workers Compensation) office that is closest to where you live. Ideally, you should do this as soon as possible.
2. Consult Legal Advice
If this process seems confusing, you should consider legal advice. More particularly, you should consider hiring an experienced Washington D.C. workers’ compensation attorney.
You might be thinking how you can possibly afford hiring an attorney after you have so many bills that you need to take care of. Well, most workers’ compensation lawyers take their cases on a contingency fee basis, meaning that if an attorney fails to win your case, you don’t pay.
In other words, you don’t need to pay anything out of your pocket to hire an attorney.
3. Prepare For A Hearing In Front of A Judge
If you get to this step, the DWC office will send you a notice about your case. In addition, you must file a Declaration of Readiness to Proceed to request a hearing in front of a judge, and your case will be heard.
The judge will try their best in reaching a settlement, and then schedule a date for trial. In the case that you and your attorney disagree with the judge’s decision, you can also file a Petition for Reconsideration.
The Most Common Reasons For Claim Denials
When taking the time to consider why your claim got denied, you need to first understand some of the most common reasons why these claims get denied, which are:
1. The Claim Was Not Filed On Time
If you miss your deadline for filing a workers’ compensation claim, your claim will immediately be denied. In most states, the deadline for filing your claim is usually between one and three years, depending on the state you are in, along with your occupation.
However, in other states, you only have 30 to 60 days to file a claim, meaning that you need to be proactive with addressing your injuries as soon as possible.
2. The Injuries Were Not Work Related
Let’s say that you work in a restaurant and you get injured walking from the dining room to the kitchen. In that case, your injury would be work-related.
On another hand, if you get injured by tripping on the sidewalk from your car to your place of work, that injury would not be eligible for a workers’ comp claim since the injury did not happen at the place of work. To make your claim more viable, it needs to be at the actual site of work, rather than a place outside of it.
3. Substance Abuse Or Messing Around Was Involved
Don’t drink alcohol or mess around on the job. Please, just don’t even think about it.
If you are a worker who works on a highway bridge that is more than three stories tall, please don’t hurt others for “fun”. If anyone gets injured due to the negligence of other workers, that could open up your company to a massive lawsuit that it can’t protect itself from.
In addition, if your employer has footage of you drinking on the job, your claim will immediately be tossed, making it even more difficult to fight for yourself.
4. You Did Not Receive Medical Treatment
One of the first things you need to do after sustaining a serious or minor injury is to seek medical attention. Even if your injuries may not seem dire, seeking medical attention should always be the first step you should take, because injuries that are not seen immediately can be devastating later in life.
Make Sure To Keep A Positive Mindset For Your Claim
All in all, filing a workers compensation claim can be a time consuming process that may seem draining and excruciating at first. However, by taking the steps of filing an application to the DWC, consulting legal advice, and preparing for a hearing, you can be better prepared than you may have thought.
In addition, you should also be prepared for learning about the specific reasons why your claim got denied, even if you may not even realize it.
Just remember, it is always worth it to fight for yourself at the end of the day, and to never give up on filing your claim, even if it may seem never-ending.