If you slip over and injure yourself while at work in a convenience store, you would expect to get your medical treatment paid for eventually through a workers’ compensation claim. Injury claims of this type are paid for by insurers who insure your employer on a no-fault basis. You don’t have to provide evidence that your employer was at fault. Even if the system seems simple, not all claims are honored. They may be denied for all sorts of reasons. Sometimes the reason is a simple administrative error or sometimes it is because your employer’s insurer thought your injury didn’t happen at work, or you failed to provide sufficient detail in your claim. If you get a denial letter from the insurer you should contact a workers’ comp. attorney to help you decide whether you should appeal. Contact The Insurance Company The denial letter from convenience store insurer may or may not have a detailed reason for denying your claim. If the letter does not make the reason clear, you should contact the insurer for a proper explanation. You may find that your accident was not properly recorded by your store supervisor or the information gave a wrong date or did not provide sufficient information. Denials may often be reversed if a simple error is noticed and then corrected. If you think that the insurer has given an invalid or unsatisfactory reason for denying your claim, you do have the opportunity to appeal the decision. This process must follow a defined procedure laid down by the workers’ compensation authority in the state you work in. it is best to familiarize yourself with the procedure before actually filing an appeal. File Your Workers’ Comp. Appeal Once you have exhausted direct communication with your employer’s insurer and you still think that the reason the insurer gave for denying your claim is invalid, you should talk to a WC attorney about filing an appeal. The whole appeal procedure is determined by the state WC authority and not by either your employer or the insurer. You may be asked to attend a mediation session first to see if there is an easy way to come to a satisfactory conclusion about your claim denial. If this doesn’t work, a formal administrative hearing will probably be scheduled. You will need to be well prepared for this hearing with as much supporting evidence to back up your claim for compensation as possible. A judge may examine the evidence you have and will also consider the viewpoint of the insurer. A decision may be made to uphold your claim or dismiss it. There are other ways you can still pursue the appeal by appealing to higher legal bodies within the state. There are time limits throughout the process which you will need to take into consideration. A Workers’ Compensation Attorney Can Help File an Appeal If you have no other choice but to file an appeal, it may be unwise to do so all by yourself unless you are very confident. It is best to talk to a workers’ compensation attorney about the original claim and the fact that it was denied. The attorney will know how to proceed with an appeal. Additional Resources Help! I was hurt working for Dollar General! What Evidence Do I Need for My Case Against Dollar General? Filing a Dollar General* Workers’ Compensation Claim in California Disclaimer: The content of this article serves only to provide information and should not be construed as legal advice. If you file a claim against Dollar General, or any other party, you may not be entitled to any compensation.
