Many workers contact a New Orleans workers comp lawyer only after their claim was denied by the insurance company. They know that they did everything by the book and followed all the rules. Yet, they were hit with a denied workers comp claim.
The fact that they decided to reach out to an attorney is a good decision. And any injured worker out there needs to know this – a denied claim is not the end of the road. A skilled lawyer can find ways to overturn this decision. Here is what an attorney can do.
1. Examine the Reason for the Denied Workers Comp Claim
First of all, the attorney needs to know the justification given by the insurer for denying the claim. The most common grounds for denial are:
- Incorrect or incomplete paperwork
- Missing a filing deadline
- The insurer believes the worker was outside job hours when the accident occurred
- The worker has a pre-existing condition and it is blamed for the current symptoms they show
- The worker did not take the drug test before going to hospital.
In most situations, more evidence and compelling legal arguments are sufficient to make the worker’s claim valid and overturn the denial.
2. Propose Voluntary Mediation
First of all, the attorney will attempt to resolve the issue outside the court system. Thus, they will reach out to the insurance company and invite them to attend mediation. This procedure is informal and puts both parties face to face.
They will present their arguments, evaluate evidence, and – possibly – reach a favorable conclusion for the injured worker. However, it is important to note that mediation can be done voluntarily. This means that both parties must agree to them.
If the insurance company refuses to mediate or maintains the denied workers comp claim at the end of mediation, your New Orleans workers compensation attorney will have to file an appeal.
3. Filing an Appeal with the Administrative Court
The next step for overturning a denied workers comp claim in Louisiana is filing a Disputed Claim for Compensation. The entire process takes between six and nine months and involves a hearing before a judge.
The hearing involves the following:
- Both sides present their evidence
- Both sides make arguments concerning their position
- Witnesses are brought to testify
- Both parties will question the witnesses.
This is just like any civil court case and will end with the judge’s decision. If the judge does not grant your workers compensation benefits, there is one more legal step you can take.
4. Appealing the Claim in Federal Court
After the administrative judge gives their decision and you are not happy with it, you have 30 days to file an appeal. However, this time you will address it to the Circuit Appellate Court, at the federal level.
This is the last legal resort for getting your benefits. In most cases, your attorney will advise you if you stand a chance to win this final appeal because each new legal process means more time and expenses.
A Skilled New Orleans Workers Comp Lawyer Can Help You Overturn a Denial
Having your workers comp claim denied is scary. You are faced with mounting medical bills, the impossibility of returning to work, and the danger of losing your job, too. But, as we explained in this article, a denied workers comp claim is not the final word on the matter.
An experienced New Orleans workers comp lawyer can help you obtain benefits, through mediation or filing an appeal. All you have to do is bring all the available evidence and be honest in describing how the accident happened.
As a new client, you benefit from a free case review, so call us today at 504-420-2755!