Fighting a denial or reduction

Fighting a denial or reduction

Fighting a denial or reduction

Denial letters from workers’ compensation often sound final. What the companies do not want you to know is it they just write them that way — a rejection does not have to be the end of the process. 

It could be difficult to think of a formal rejection letter as a persuasive document. However, insurance companies typically work very hard and take every liberty possible to minimize every claim. There are rules, but the corporations do have some freedom in how they communicate. 

In any case, a common goal of insurers is to improve their bottom lines by denying applications and cutting costs. With that in mind, it makes sense that they would try to persuade you not to follow up on a valid claim. 

Simpler than it seems

If this happens to you, do not despair. There could be options. 

This system is not as complex as it might seem — or as the insurers might have you believe. Of course, context and analysis are often necessary to save time and avoid further rejections. However, once you understand the legal and administrative reasons for your denial, you could probably complete your application yourself with no specialized training. 

Fairer than you might expect

Your employer does not get to decide whether you receive payment. In fact, neither does your employer’s insurance company. The deciding factor is the law. 

If you prepare a complete, accurate Application for Adjudication of Claim that outlines the truth about why you deserve your benefits, it would not matter how powerful of an opponent you face. If the Workers’ Compensation Act entitles you to payment, corporations do not get a vote. 

Not everyone sees reason right away. Through knowledge, persistence and organization, you should be able to convince your employer or the insurance adjuster to pay you what you deserve.