When it comes to the workers’ compensation process in Springfield, you have the right to appeal an unfavorable or unfair decision. You could appeal the decision if you were denied benefits entirely or if you disagree with the amount of compensation you were awarded. In either situation, having an experienced workers’ compensation attorney in your corner is crucial.
Navigating the appellate system can be difficult on your own. Steven L. Schepps, a seasoned Springfield workers’ compensation appeals lawyer, is here to guide you through every step of the process. Call to learn more.
Why Denials Happen
The workers’ compensation system is considered “no-fault,” which means that workers are entitled to compensation for work-related injuries without the need to prove that negligence occurred. In many cases, these benefits are available to employees who are responsible for their own accidents. Despite the nature of the system, the reality is that many claims are ultimately denied by insurance companies. The reasons for those denials can vary. A Springfield workers’ compensation appeals attorney could assist with unfair denials based on the following reasons:
Outside the Scope of Employment
It is important to remember that this system of benefits is exclusively for injuries or illnesses that happen at work. Many denials allege that an injury did not occur during the scope of a worker’s employment. That could mean the injury occurred during off-hours or at home. It could also mean it occurred at work but during an activity that was not within the scope of employment, like a fight or horseplay. An attorney could fight back against a denial of this nature, providing evidence that the injury did happen while on the job.
A worker is not entitled to compensation for an injury that existed prior to the work-related accident. While pre-existing conditions are not covered in every case, it is important to note that sometimes they are. For example, it is improper to deny a claim for a pre-existing condition that was aggravated or made worse by a workplace accident.
Some insurers could deny a claim after disputing the severity of the injury. Even if there is no question that an accident happened, an insurer might insist that the injuries are not enough to prevent an employee from returning to work. Denials could also happen when the insurance company believes that requested medical care is unnecessary or unrelated to an injury. A lawyer could use evidence such as hospital records to establish the severity of a workplace injury.
Informal Hearing vs. Formal Claim Petition
There are two immediate options available following the denial of a workers’ compensation case. An injured worker could choose to either move forward with an informal hearing or file a formal Claim Petition. A Springfield workers’ compensation appeals attorney could advise on which option is best.
An Application for Informal Hearing results in a hearing with a judge that is something closer to mediation than a trial. Often, the judge will suggest a settlement offer that both sides can either accept or reject. If either side rejects the proposal, the appeal continues.
A Formal Hearing is more like a trial. It is overseen by a judge, and both the injured worker and the insurance company have the opportunity to present evidence. It is also possible to appeal the decision in the Formal Hearing to state court.
Reach out to a Springfield Workers’ Compensation Appeals Attorney
A denied claim does not have to be the last word in your workers’ compensation case. You have the right to appeal, and you have the right to hire an attorney to assist with that appeal. Contact a Springfield workers’ compensation appeals lawyer to get started. There is no cost to you unless we recover, so do not hesitate to reach out and set up your free initial consultation with dedicated attorney Steven L. Schepps.