When you go to work, you expect to be working in a safe environment. You expect that you can return home at the end of work without any injuries or illnesses that have arisen because of your job. In Vermont there is a legal requirement that nearly every employer has to have insurance coverage for their employees. In the event of an accident or an illness at work, the employee has the right under state law to make a claim for compensation with the insurer who is providing workers’ compensation cover. Not every claim is accepted. Some claims may be denied outright or the compensation requested challenged or reduced. A denied claim can be appealed against with the help of a workers’ compensation attorney. Workers’ Comp. Law in Vermont The state agency that oversees workers’ compensation payments and appeals in Vermont is the Workers’ Compensation Division (WCD). Nearly every private employer in Vermont is required to have workers’ compensation insurance either with a private carrier or to self-insure. In practice, only large well financed and long established companies self-insure. Workers who are genuinely injured at work or develop a work related illness should inform their employers as soon as they can give details of the time, date and nature of the injury(ies) or illness and how it happened. Your employer should notify the insurer of your claim. If this doesn’t materialize, you can file a claim directly with the WCD. A workers’ compensation claim in Vermont is a no-fault claim, which means you don’t have to prove that the employer was at fault and that the claim is still acceptable even if you were responsible for the accident as long as it wasn’t malicious. Your employer will normally let you know their preferred doctor for initial diagnosis or examination, but you can then choose your own doctor if you apply to the Workers’ Compensation Division. Why a Workers’ Comp. Claim Might be Denied It can seem very frustrating to be told that your employer’s insurer has turned down your claim after a workplace injury or illness. They are required to provide a reason or reasons and this will provide you with the basis to mount an appeal. There are several straightforward reasons why a claim is denied. The injury or illness may have never been reported on time, information about the injury or illness was lacking in detail, or the insurer has reason to believe that the injury or illness was pre-existing. These are all contestable claims. Insurers may have other reasons for denying a claim, such as one of the following allegations: You had been drinking at work or were drunk or affected by drugs at the time of the accident. You brought the accident on by playing a prank or foolhardy behavior. You habitually did not use safety equipment or clothing which was provided at work. You deliberately failed to follow established guidelines for safety which led to an accident happening. How the Workers’ Comp. Appeals Process Works in Vermont It can be annoying and frustrating if your claim is denied, but this doesn’t mean you won’t eventually obtain the compensation you deserve. An appeal can result in the denied claim being overturned, but it might take several months of perseverance and careful collection of evidence that supports your case. The first step in the appeal process is to request a hearing with the Workers’ Compensation Division (WCD). They will then set a date for the hearing, but may suggest an informal meeting with the insurer’s representative and a neutral third party. Some disputes can be resolved quite quickly in this manner. If mediation as described above doesn’t help, then the hearing will be the next level in the appeals process. The hearing is a formal occasion, more like a court appearance, although it will take place in a WCD venue. The administrative judge appointed to be present at the hearing will make a decision after examining evidence and listening to your account and the opposing arguments provided by the insurer. The judge will then make a decision based n what has been heard, but you can still appeal to the state’s Court of Appeals if unsatisfied. Why You Should Hire a Worker’s Comp. Attorney If your claim has been denied and you are contemplating an appeal, you should discuss the claim with a workers’ compensation attorney. The attorney can assess the documentation you have and why the insurer has denied the claim and suggest what steps you should take. As most workers’ comp. attorneys work on contingency, it makes sense to allow the attorney to represent you wherever necessary, such as at the formal hearing.
