WORK COMP - DENIAL OF CLAIM

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WORK COMP - DENIAL OF CLAIM

25 May, 2018

WORK COMP : DENIAL OF CLAIM

 Q. In some circumstances a worker sustains an injury and asks the insurance company to provide benefits. After investigation the insurance company responds that it believes there is no merit to the claim and refuses to make payments of medical, or other weekly benefits. Does this position by the insurance company end the worker’s right to benefits?

  A. No. Very often an insurance company will conduct its investigation quickly and miss important points concerning the facts, or the law pertaining to an injury. The denial of the claim by the insurance company does not diminish, in any regard, the rights of the worker.

            It is disappointing that an insurance company will not immediately accept the claim as compensable but this does not mean that you should stop your efforts to provide information, or factual material that will support the claim. Sometimes the doctor is asked whether the work injury caused the problem requiring surgery or treatment. The doctor may answer no if the worker had a pre-existing condition which was lit up or aggravated by the work. Yet, the claim would be compensable. Sometimes, the insurance company will have conflicting evidence and deny a winnable claim.

             Understand that an insurance company is in an adversarial relationship with you. Its only interest is to take care of the insurance company, not you. For that reason you do not have to rely upon the insurance company to figure out the strengths and weaknesses of your case. Once the insurance company has the appropriate information, and still refuses to provide benefits, you should consult with an attorney of your choice to determine if the insurance company is wrong.   
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