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Dealing with a denied workers’ comp claim

On Behalf of | Apr 21, 2023 | Workplace Injuries

The creation of workers’ compensation provides a safety net for workers in Kentucky if they are injured on the job. The funds paid out cover medical expenses and treatment for workplace accidents or injuries. It also pays for treating illnesses related to the work environment, such as repetitive motion injuries and respiratory conditions caused by inhaling harmful fumes. But what are the options if a claim is denied?

How workers’ compensation works

The workers’ compensation insurance program was created to provide funds for lost wages and medical expenses when an employee is injured or becomes ill as a result of their job. Under Kentucky employment law, any company with one or more employees is required to carry workers’ comp insurance. Contributions to support the program are entirely paid by employers so that none of the expense is borne by workers.

Common reasons for claim denials

As with many types of insurance claims, workers’ compensation payouts are only disbursed after approval. Injured workers have up to two years to file a claim in Kentucky. The approval process usually consists of:

  • Documenting the injury
  • Gathering information about the incident, including any security camera footage and eyewitness statements
  • Medical reports
  • Proof of living and medical expenses

Claims can be denied for a number of reasons, including:

  • Missed filing deadlines
  • Injuries that fail to meet state guidelines
  • Claims filed after leaving the job
  • Conditions that are determined unrelated to the job

If a claim is denied, it’s not the end of the case; you do have options.

The next steps

The most common option is to appeal the claim denial. This usually involves consulting a professional to handle the appeal, gathering any evidence and paperwork needed to prove the claim and making sure that everything is done within the legal timeframe. Of the total number of claim denials, approximately 67% are approved on appeal.

The claimant has 30 days to appeal a decision, so time is of the essence. Altogether, it can take up to 18 months for the entire process from initial claim to payment.