What options do you have if your Workers Compensation Claim is denied?

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Most employees know that if they are injured at work their claim for lost wages and/or medical treatment must be approved through their employers’ workers’ compensation insurer. However, not all employees understand that even if the injury occurred at work, it is possible for the insurance company to deny the claim.

Initially if you are injured at work, you must report it to your employer. Once you report the injury and provide your employer with the details of the accident/injury and medical evidence of treatment and/or billing; the employer must report the injury to their worker’s compensation insurance carrier. At this time the employer must provide their insurance company with proper documentation of the injury and any necessary medical treatment that has been incurred by the injured employee. The employer must also report any lost time from work that resulted from the injury.

But even once this notice is given by the employer to the insurance company, the insurance company can issue a denial of the claim. This is called a section 78 Notice. For this notice to be legally sufficient it must contain the following information;

  1.  An explanation as to why the injury is being disputed
  2. The reasoning as to how the insurance company came to that conclusion
  3. Instructions as to how you can dispute the insurance company’s denial of your claim

Once you receive a section 78 Notice you have options. First and foremost, it is important to remember that you do not have to prove your employer was negligent to be entitled to collect workers’ compensation benefits. Workers’ Compensation is known as a no-fault system, which means that if the injury happened at work, it is irrelevant whose fault it was.

Next you will have the option of requesting a review of the insurance company’s decision. You can request the review in two forms;

  1. Request a review by the insurance company which will give the company a chance to reconsider your claim
  2. You can file an appeal with the Workers’ Compensation Commission; this can be done with the assistance of a solicitor who specializes in the area of Workers’ Compensation Law.

While you can take one or both of these actions on your own, it is best to consult with a solicitor who specializes in this area of law. A solicitor can review your claim and complete all of the necessary paperwork to the Workers’ Compensation Commission. If the Commission finds that your case is worth further scrutiny, a teleconference will be scheduled for the parties to confer and discuss the denial and the appeal. While you can handle this on your own, again it is best to have legal representation.

A lawyer can help with the following;

  • Completing the Response to the 78 Notice
  • Securing the proper and necessary medical evidence to support your claim
  • Filing the medical evidence in a timely manner
  • Attending the teleconference with you before the arbitrator
  •  Making a proper and appropriate request for lost wages and payment of past medical bills and ongoing treatment bills

In addition, it is important to remember two final details. First, one of the responsibilities of your solicitor will be to make sure that your complaint process aligns with all of the necessary timelines. Legal timelines are important and you do not want to miss a deadline in the process. Second, you will not be charged any fees for the use of a solicitor. Instead if your lawyer is approved by the Workers Compensation Independent Review Office (WIRO), the fees will be paid by WIRO.

While getting injured at work can be stressful and painful, and you can handle a denial on your own, it is best not to. There are very few, if any, downsides to seeking legal assistance if your Workers’ Compensation claim is denied. As such, it is always best to seen assistance for a 78 Notice of Denial of your workers’ compensation claim.

In the event that you find yourself in need of assistance regarding your workers compensation claim, please contact the law offices of Owen Hodge Lawyers. At Owen Hodge, we are always happy to assist clients in understanding the full ramifications of any and all of your legal needs. Please feel free to call us at your earliest convenience to schedule a consultation at 1800 780 770.



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