If your Arizona workers’ compensation claim has been denied, you have a right to an appeal. Given the challenges of navigating the worker’s comp system, it is wise to have an accomplished workers’ compensation claim denial attorney by your side.
Disability Attorneys of Arizona is highly experienced in handling workers’ comp claim denials. Our dedicated workers’ compensation appeals lawyer is a highly respected advocate of injured workers who will fight for the benefits you deserve. Contact our Phoenix office today to schedule a free consultation.
Common Reasons for a Workers’ Compensation Claims Denial in Arizona
Although workers who suffer on-the-job injuries or occupational illnesses are entitled to workers’ compensation benefits, claims are frequently denied for the following reasons:
- Failing to Promptly Notify the Employer About the Injury. One of the most common reasons a claim is denied is that the employee did not promptly notify the employer of the injury, or as soon as reasonably possible. By failing to do so, you may forfeit your right to workers’ compensation benefits. In addition, after receiving your notice, the employer must also report the injury to the Industrial Commission of Arizona (ICA) within 10 days.
- Failing to File a Claim Within the Deadline. You must also file a workers’ compensation claim to the ICA within 1 year of the date of the injury or illness. If your claim is not filed within this time period, or is incomplete, or inaccurate, the claim will be denied.
- The Injury Occurred Outside the Scope of Employment. Your injury must have occurred in the course of performing work-related duties, while on the employer’s premises. If you slip and fall on the sidewalk during a lunch break, for example, you are not eligible for benefits. On the other hand, an injury that occurs while you are running an errand for your employer, such as delivering a package to a client, means that you were on a “special mission” and are therefore entitled to benefits.
- The Employer or Workers Compensation Insurance Carrier disputes the claim. Your employer may dispute that the injury was work-related or the insurance carrier may claim your injury was a pre-existing condition. Therefore, it is crucial to provide evidence, including a statement from the doctor who treated you, that your medical condition is work-related.
Workers’ compensation claims can be denied for a variety of reasons, each of which can be frustrating and confusing for the injured employee. Understanding these potential pitfalls can help you avoid common mistakes and increase your chances of a successful claim. Here are some additional reasons why a workers compensation claim denied:
- Lack of Medical Evidence to Support the Claim:
- One of the most common reasons for denial is insufficient medical documentation. To be eligible for workers’ compensation benefits, you must provide clear and convincing medical evidence that your injury or illness is directly related to your job. This typically includes detailed medical records, diagnostic tests, and physician statements that establish a connection between your work and the injury. Without this evidence, the insurance company may argue that your condition is not work-related, leading to a denial of your claim.
- The Employee Failed to Seek Appropriate and Prompt Medical Attention:
- Timely medical treatment is crucial after a workplace injury. If you delay seeking medical attention or fail to follow up with recommended treatments, the insurance company might argue that your injury is not as serious as claimed or that it was aggravated by the delay. Promptly visiting a healthcare provider not only ensures your health and safety but also strengthens your workers’ compensation claim by providing immediate documentation of your injury.
- The Employee Sought Medical Care from an Unauthorized Health Care Provider:
- In many states, workers’ compensation laws require employees to seek treatment from a network of authorized healthcare providers chosen by the employer or their insurance company. If you receive treatment from an unauthorized provider, the insurance company may deny your claim, arguing that the treatment is not covered under your workers’ compensation benefits. It’s essential to confirm that your chosen healthcare provider is approved under your employer’s workers’ compensation plan.
- The Injury or Illness Is Not a Qualifying Medical Condition:
- Workers’ compensation only covers injuries and illnesses that are directly related to your job. If your condition is deemed to be unrelated to your work, pre-existing, or not severe enough to qualify for benefits, your claim may be denied. For instance, certain repetitive strain injuries or stress-related conditions may not be covered unless you can demonstrate a clear link to your job duties. It’s crucial to work with a medical professional who understands how to document your condition in a way that meets the requirements for workers’ compensation.
- A Blood Test Shows Drug or Alcohol Use at the Time of the Injury:
- If a blood test conducted after your injury shows the presence of drugs or alcohol, your workers’ compensation claim is likely to be denied. Employers and insurance companies often argue that an employee’s impairment was the primary cause of the accident, rather than a workplace hazard. This defense can be difficult to overcome, as most states have strict rules regarding drug and alcohol use in relation to workers’ compensation claims. However, if you believe the test results were inaccurate or unrelated to your injury, you should consult with an experienced workers compensation attorney who can help challenge the denial.
These are just a few of the many reasons a workers’ compensation claim may be denied. Understanding the potential obstacles in the claims process can help you take proactive steps to avoid them. If your claim has been denied, it’s important to seek legal advice promptly to explore your options for appeal and ensure your rights are protected.
How an Arizona Workers’ Comp Appeals Lawyer Can Help
At Disability Attorneys of Arizona, we know that having a workers compensation claim denied can add to the stress of being injured and unable to work. Our legal team will have you navigate all aspects of the workers’ compensation appeals process, including:
- Request a hearing — You have 90 days from the date you receive the denial notice to request a hearing with the ICA. Your request must be in writing. The ICA will notify you of the date of the hearing, which will be conducted by an Administrative Law Judge (ALJ).
- Prehearing conference — The ALJ assigned to your appeal may require the parties to participate in a prehearing conference (usually by phone) to discuss the case.
- Discovery — Before the hearing, the parties are required to exchange information and material related to the case. The discovery process allows both sides to request and review evidence related to the appeal. Discovery also includes a deposition during which the insurance carrier’s attorney will question you under oath.
- Hearing — A workers’ compensation hearing is held 90 days after referral to the ALJ. You will be asked to testify and must be able to demonstrate that your claim is valid. The ALJ will question all the parties and there may be one or more additional hearings to review the medical evidence.
The ALJ will render a decision within 30 to 60 days after the final hearing. If your appeal is denied, you may file a request to review within 30 days. The ALJ will re-examine the evidence and issue a decision either reversing or confirming the original decision.
If your claim is still denied, you have a right to file an appeal with the Arizona Court of Appeals within 30 days of the review decision.
Why Choose Disability Attorneys of Arizona for a Workers’ Compensation Claim Denial
Our firm has a proven history of helping our clients obtain the worker’s compensation benefits they deserve. Whether you are filing an initial claim or need assistance with your appeal, our denied workers compensation claim attorney will guide you through the process and make sure your rights are protected.
Let Disability Attorneys of Arizona handle all the details of your workers’ compensation claim so that you can focus on recovering while we use our expertise in Arizona workers compensation law. Contact our office today to learn how we can help. You will not pay any attorneys’ fees until we obtain benefits for you.