Injury or illness at work is always a possibility, even if it is only a slight one. Most Delaware employees are covered by workers’ compensation insurance, which their employers are required to take out to provide medical benefits and compensation for time lost at work. The insurance scheme also helps to protect the employer from litigation by the employee. Not every claim made is successful. Some claims are denied by the employer’s insurance company. This doesn’t mean you can’t obtain rightful compensation, but it might take longer and involve an appeal. A workers’ comp. attorney can advise you of your rights and help you with an appeal. Workers Compensation Law in Delaware Like most other states, Delaware has a state agency that is dedicated to dealing with workers’ compensation. The Office of Workers’ Compensation oversees state workers’ compensation laws and will adjudicate in the event of a dispute. If you do become injured or develop a sickness while at work, you should first make sure that your employer is notified. State law requires you to do that within 90 days of the injury or recognition of the illness. Your employer will inform its insurer and you should then make a claim for compensation. A successful claim in Delaware should result in recovery of the full cost of medical treatment as well as a percentage of any lost wages. The amount of lost wages is partly determined by the time you have been working for your employer. Delaware workers’ comp. laws are designed so that you can ultimately return to work, although this is not guaranteed. Workers’ comp. insurance is of the no-fault type, so you are not required to prove that the employer was at fault. Why Your Claim Could be Denied Many compensation claims are denied for quite simple reasons. In some cases it is because employees fail to let their employer know what happened or did so too late. Insurers are reluctant to release compensation payments if there is the slightest reason to avoid doing so. Sometimes there is a lack of communication between employer and insurer which results in a claim that the employee was not at work when an accident happened. These discrepancies can usually be cleared up and the claim process resumed. Insurers may also more seriously allege that you: were not injured or became sick genuinely at work or that the injury or illness was a pre-existing condition; fabricated the injury; did not follow correct safety procedure even though you knew what you should have done to protect yourself from injury; were fooling around at work and that this led to your injury; were intoxicated or affected by drugs at the time of the accident. Any one of these allegations can be refuted by you, if incorrect, when you appeal against the decision. Delaware’s Workers' Comp Appeals Process If unsatisfied by your employer’s claim denial or by a less than satisfactory award, you are able to appeal against the decision by filing a petition with the Office of Workers’ Compensation. If you do decide to go down this route, you should be prepared to take it very seriously, make sure you have sufficient evidence to back up your claim, possibly look for witnesses who can verify what you have said about the workplace injury or illness. The petition is followed in due course by a hearing where booth your complaint is heard as well as the grounds for denial by the insurer. The hearing may be followed by a more formal hearing or trial presided over by a judge. The judge will make a decision about your claim which in most cases tends to be the final one. If still unsatisfied you can appeal further to the county Superior Court where the decision by the judge may decide the fate of your original claim. Why a Workers' Compensation Attorney May be of Help Making an appeal against a denied workers’ compensation claim is not for the faint hearted. It is advised that you seek legal help at least for advice. A workers’ comp. attorney can explain what you have to do before the first hearing with the Commissioner from the Office of Workers’ Compensation and represent you at any hearing or trial.
