Workers’ Comp Claim Denied? What Now?
By Emily L. Raisis, Esq.
Suffering a work-related injury can be physically and emotionally overwhelming. For many workers, filing a workers’ compensation claim can be intimidating. However, often filing a claim is a means of ensuring that you are receiving the benefits and compensation you are entitled to under the law.
Workers compensation benefits in Delaware can include compensation for; lost wages, medical expenses, mileage, permanent impairment and disfigurement.
The first step to recovery under Delaware workers’ compensation is ensuring your claim is accepted. If your claim is denied (or benefits are paid without prejudice), you must take action.
Under Delaware law, you have two years from the date of injury to get your claim accepted – this is called your statute of limitations. Failure to get your claim accepted within the prescribed period of time, will result in a denial.
What should you do if your claim is denied?
Step 1: Understand the reason for the denial
The first step is to review the denial letter you received. Delaware employers (and their insurance carriers) are required to provide written notice of the denial and state the reasons behind it. Common reasons for denial include:
- The injury did not occur during the scope of employment
- The claim was not reported in a timely manner
- There was insufficient medical evidence to support the injury
- The injury was pre-existing or unrelated to work
- Paperwork errors or incomplete documentation
Step 2: Gather evidence and documentation
As the party seeking compensation, the burden of proof lies with you. It is important to build a case in support of each aspect for which you are seeking compensation. Often times, the following can be helpful:
- Medical records from treating physicians
- Witness statements from co-workers
- Accident reports
- Timecards or work schedules showing your presence on-site
- Surveillance or video footage, if available
- Testimony from your doctor
Step 3: File a petition with the Delaware Office Of Workers’ Compensation
Regardless of the reason for the denial, a petition will likely need to be filed with the Delaware Office Of Workers’ Compensation. This initiates a formal legal process to challenge the denial.
Once the petition is filed, a pretrial hearing will be scheduled at which time your case will be set for a hearing date before the Delaware Industrial Accident Board (IAB or Board).
Step 3: Discovery
Prior to the hearing, parties will engage in the discovery process.
Discovery is the process in which both sides exchange information and gather evidence relevant to the case prior to the hearing.
One form of discovery in workers’ compensation cases, deals with expert testimony. Medical testimony is often an essential part of workers’ compensation claims. More often than not, due to their hectic schedules, medical experts will testify prior to the hearing by way of deposition. A deposition is out of court, sworn testimony, that is written and transcribed. Deposition testimony is then submitted at the hearing, carrying the same weight as if it were being presented live.
Step 4: The hearing
At the hearing, both parties present their case.
The Board will issue a decision in the weeks or months following the hearing. The decision is final unless appealed by either party under the prescribed period of time.
Final thoughts
Facing a denied workers’ compensation claim can be stressful – the attorneys at Kimmel Carter are experienced in navigating these situations and litigating cases to ensure you receive the compensation you are entitled to.
Don’t give up if your claim is denied—understand your rights and contact our office today to discuss your options. Call or text us anytime at 302-565-6100
or visit our website at www.kimmelcarter.com.
Bio
A graduate of Catholic University and Widener School of Law, Emily L. Raisis, is now a senior associate attorney in the Newark office of Kimmel, Carter, Roman, Peltz & O’Neill, P.A.
Praised by the firm’s leadership for her superior research skills, legal writing and her strong rapport with clients, Mrs. Raisis worked as a law clerk with Kimmel Carter throughout her time at Widener and was promoted to the position of associate following her graduation. She is barred in Delaware, Pennsylvania, New Jersey, and the U.S. District Court of Delaware. She is also a member of the American Association for Justice (AHA) and the Delaware Trial Lawyers Association (DTLA).
Mrs. Raisis is a lifelong Delawarean, and she is ready to do what it takes to get First State injury victims the compensation they deserve.
Testimonial
“Emily was fantastic! She was incredibly patient with me and secured ten times more than the initial offer. She’s extremely knowledgeable and kept in constant communication, updating me anytime there was new information. I will definitely recommend Emily and her law firm!” ~ Michael H.
Kimmel Carter
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