There’s always a chance of a workplace accident or illness. It might not happen that often, but when it does, it can be reassuring to know that your employer has you covered by workers’ compensation insurance. This is mandated by the state for most employers with some important exceptions. As long as the accident or illness was genuinely workplace related, the employee should be able to recover medical costs and part of any wages lost because of injury or illness. Not all claims are honored. If the insurer denies a claim, it is possible to make an appeal. If it comes to this, it is better to get the help of a workers’ comp. attorney. Workers Compensation Law in Nebraska The Nebraska Workers Compensation Court oversees disputes over compensation between employers and their insurers and employees when there is a problem with a claim. Nebraska, like most other states, has specific laws governing workers’ compensation. All employers who employ more than one employee must have workers’ comp. insurance. The only exceptions are for domestic workers and independent contractors. Employees who are injured at work or become sick must inform their employer as soon as possible and make sure they submit a workers’ compensation claim within two years from the incident happening. When compensation is awarded it should cover all reasonable medical costs as well as rehabilitation, if needed and a portion of the wages that have been lost. This averages out at two thirds of the average wages that might have been earned. Why Your WC Claim Could be Denied in Nebraska WC Denials happen for a number of reasons. Sometimes, the employee has simply not managed to keep to the rather rigid time limits involved in making a claim. Other common reasons turn out to be administrative errors that originate in the workplace. Usually, if this is the case, e.g. it was claimed that you were not at work when the incident happened but you are certain that your presence at work on that day was recorded, then it can be rectified fairly easily. The insurer will also deny a claim if any of the following occur or are alleged to occur: the injury did not happen at work; the illness was pre-existing; no medical expenses have been documented; the illness is due to mental health deteriorating; the injury or illness happened because the employee failed to stick to safety guidelines or use safety equipment; the employee was intoxicated or was under the influence of drugs; The Nebraska WC Appeals Process There are several options if your workers’ comp. claim is denied. You can challenge the decision by contacting the Nebraska Workers’ Compensation Claim but if you do go down this route, you should make sure you have able legal representation to advise you and represent you if the appeal goes to trial. There are three main steps involved in a Nebraska workers’ comp, appeal. You can discuss the claim you made with a public information specialist. This is basically legal information that will help you see whether your claim was justified in the first place and what you could do to improve your case. The second step is to request an informal dispute resolution meeting. This will be an attempt at mediation. At the meeting you have a chance to demonstrate that you had a right to be compensated and to show what evidence you have to back your claim up. The insurer will also have a representative there, probably an attorney, and will present their side of the denial decision. Many disputes are amicably resolved at such a hearing. If you are still dissatisfied with the result of the hearing, you can still request a formal administrative hearing. This will be heard by a judge appointed by the Nebraska Workers’ Compensation Court. Again both sides of the dispute together with any witnesses and other evidence will be reviewed and a decision made by the judge either in your favor or not. The final step, which is certainly not to be taken lightly, is to appeal to the Nebraska Court of Appeals. Why a WC Attorney May be of Help It can be very frustrating hearing that your workers’ comp. claim has been denied. The whole process of appealing might seem to be like climbing a mountain. If you are convinced that you should have been awarded compensation, then talk to an experienced workers’ compensation attorney before submitting your petition. The attorney can advise you whether it is worth appealing, help you with the petition and represent you at the hearing if it gets to that stage before resolution.
