There can be nothing more unsettling than having your workers’ compensation claim denied. It’s bad enough suffering from serious injury or illness at work without it being recognized as genuine. If you didn’t get any advice from an attorney the first time around, then don’t ignore the benefits of sound legal advice if you are considering an appeal. If you have been saddled with big medical bills and have lost a considerable amount of earnings while off work, you may be depending on the board’s decision being overturned. The AmTrust Group – Company Profile Your employer may have sought workers’ compensation insurance cover with AmTrust Financial Services Inc. This company is a major supplier of workers’ comp. insurance across America. It is a multinational company based in New York and specializes in providing property and casualty insurance. It operates outside of the U.S. in Britain and Europe. Your employer may be insured with an AmTrust subsidiary rather than with the parent company itself. If your claim has been denied, it may be because of a decision made by the insurer, so it will be important to track down the name of the insurer and a contact so that you can make enquiries before you make an official appeal. 4 Tips to Help Prepare for a WC Denial The decision to deny your workers’ compensation claim usually comes from your state’s department of labor or a state workers’ compensation board but the real problem may lie in information that your employer or the insurer has provided the board. The denial letter will list the reason or reasons why the claim has been denied and so it is important to read this first before embarking on any further course of action. Tip #1: Check with your employer and / or your employer’s contact in the company providing workers’ comp. insurance. There may be a simple mistake made by someone in an office which you can sort out yourself easily. This is usually due to a mistake in dates and times or there may be a more serious complaint e.g. that your illness or injury did not happen at work. Tip #2: If the problem is not a simple one, i.e. not an administrative mistake, yet you still believe you have a strong case for a claim, it will be certainly worth getting advice from a workers’ comp. attorney. The attorney will be able to assess your case and suggest whether an appeal is likely to succeed. Tip #3: The next step depends on the reason for the denial. If there is no administrative mix-up and you advised your employer through a supervisor of the injury or illness in time as well as submitting a claim in the specified time, you have a better chance of an appeal being heard. With the help of your attorney make a list of everything you submitted with the initial claim and work out what, if anything, was missing or what could help support an appeal. Tip #5: You will be called for an administrative hearing which will have a judge in attendance. This is the opportunity for you to present any documentation that will help your case. Most claims are denied because the claimant has not shown clearly enough that the injury or illness happened genuinely at work and that it required medical treatment which you can document clearly. A claim for an injury which you had but did not have medical treatment for will probably be denied, for instance as there are no identifiable costs that can be compensated for. How a WC Attorney Can Help You With a Denied Claim Insurers as well as employers may be bound to pay insurance claims, but are generally loathe to do so unless the details are quite clear cut. It is possible that either your employer or the AmTrust subsidiary that is providing WC cover is trying to wriggle out of paying compensation using the fact that your documentation or legal knowledge is insufficient. This is where an experienced workers’ comp. attorney can really make a difference. The attorney will not advise you to go ahead with an appeal unless he or she thinks it is sensible to do so. Use an attorney if your claim is denied and listen carefully to the advice given. *The content of this article serves only to provide information and should not be construed as legal advice. If you file a claim against AmTrust Group, or any other company, you may not be entitled to any compensation.
