Have you been injured in an accident at work or become ill due to workplace conditions? You may be eligible for workers’ compensation. This is paid out of insurance cover which your employer should have with a reputable insurance company like the Zurich Insurance Group. Workers compensation claims can help pay for out of pocket medical expenses and lost earnings due to absence from work. Workers’ compensation is not automatic. You have to go through a claims process within a specified time frame. Claims are not always honored and you may have to appeal a claim if it is denied. That’s when a workers’ comp. attorney becomes a valuable asset. The Zurich Insurance Group – Company Profile The Zurich Insurance Group is a major international insurance provider that is headquartered in Switzerland, hence the name of the company. The U.S. subsidiary, which your employer may take out workers’ compensation insurance with is called Zurich American Life Insurance and has its U.S. headquarters in Schaumburg, Illinois and New York City. Overall, the Zurich Group employs 60,000 people worldwide and is listed as the world’s 78th largest company. Tips for Handling a Workers’ Compensation Claim Denial You will be notified by your state's workers’ compensation board or state labor board if your claim has been denied. The reason(s) given for denial will be listed on the denial letter. You may be able to appeal the decision with the help of an attorney. It all depends on why your claim was denied. Tip#1. Find out whether your employer or their insurance adjuster made some kind of simple mistake when they sent information into the board. A time or date missing or incorrect may make all the difference when a claim is assessed and can be easily rectified. Tip#2. If there has been no simple administrative error, you may have no choice but to appeal. It is best to approach an experienced workers’ comp. attorney at this stage and show him or her the documentation you submitted with your claim. The attorney can advise you how to go about appealing and whether this is likely to succeed. Tip#3. Submit an appeal on advice from the attorney. Make sure this is within the time frame allowed. You will at some point receive a date and time for an administrative hearing where a judge will listen to your reasons for an appeal. Tip#4. Before you attend the hearing, obtain any additional documentation or witness statements that may help your case. The type of documentation needed depends on the reason for the denial. It usually comes down to your employer challenging the fact that you were genuinely injured or became ill at work or that you did not provide sufficient information showing the medical treatment you obtained or how much it all cost. In some cases, it may be because you did not show any evidence for medical treatment at all. Your attorney will advise you about relevant paperwork. How to Appeal a Workers' Compensation Denial If you have been denied workers’ compensation by Zurich Insurance, your employer’s insurer, you may be able to appeal the denial. This is not an easy process but if you believe your denial is not justified, it is a route you can take to help insure you get the compensation you deserve for an injury that took place at work. Reasons for a Denial Zurich Insurance will do its best to deny a workers’ compensation claim if it has the evidence to do that. You will know if your claim has been denied as you will receive a letter from Zurich Insurance. These are some common reasons why your workers' compensation claim may have been denied: an error in your workers’ compensation claim application; proof found that your injury didn’t take place while at work; your injury was the result of a preexisting condition or injury your health provider made the decision that your work injury has not disabled you; you didn’t report your accident and injury to your workplace on time; the statute of limitations in your state had been reached. Steps to Follow to Appeal a Denial Before beginning the appeal’s process you should contact Zurich Insurance to find out why your WC claim was denied. Often, there is a denial because of a mistake made somewhere in the paperwork. This can often be resolved quickly if the mistake was found to be a genuine error made by your employer or the Zurich Insurance company. It might be your fault for failing to provide an essential document. At this point in time you can make a plea to Zurich Insurance to reconsider your case before resorting to the appeal’s process. If this does not solve the denial what is most important next is you need to appeal within the deadline set after your claim was denied. In some cases the following events take place. Most appeals end up at a hearing before an administrative law judge, who will make a ruling on your claim. If Zurich Insurance won’t reconsider its decision, once you know the reason for the denial you can get help from a workers’ compensation lawyer to file the appeal. You will need to gather any documentary evidence to support your claim. This may mean contacting any witnesses to the accident and your medical treatment provider who is prepared to vouch that your injuries are serious and are due to your accident at work. You may also need an independent medical treatment provider to provide a diagnosis. It is important that you find out what the process is for appealing your workers’ comp. decision as not all states follow the same appeal process. What Happens at the Appeal Hearing? Before your appeal goes to the administrative judge it may be heard at a review board first. These hearings are like court trials, but no jury is present. Witnesses could be called to testify that your accident and injuries took place at work. You will need to provide any other documents or evidence to show that you were, in fact, injured on the job, the injuries are permanent and a direct result of the injury that took place at work. This will then be passed to the ALJ to be considered. What Happens if the Appeal is Denied If the ALJ denies the appeal the next stage is an appeal to the Workers' Compensation Court of Appeals or another appeal board, depending on the state. If this second appeal is allowed, a hearing will be set before a panel of three board members who will review the case. At this stage no new evidence can be introduced. The court will only consider the ruling made by the ALJ or review board and it will affirm, modify, reverse, or remand the case for further proceedings or findings. In a few states, if the panel decision does not make a final decision unanimously, the injured employee may be able to request a full board review. Typically, an appeal of an administrative law judge’s decision must be made within 30 days of the decision. How an Attorney Can Help You With a Denied WC Claim Workers’ compensation attorneys understand the reasons for denial and will be able to advise you how to go about reversing a decision if this is practicable. Even if you hadn’t contacted an attorney when you submitted your initial claim, it makes sense to do so if your claim has been denied. *The content of this article serves only to provide information and should not be construed as legal advice. If you file a claim against Zurich Insurance Group or any other company, you may not be entitled to any compensation.
