Denial of Workers’ Compensation Claims in Denver

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Most people expect that if they have been injured on the job, they will automatically receive workers’ compensation benefits. However, the denial of workers’ compensation claims in Denver does occur. There are many factors that go into the approval and/or denial of a workers’ compensation claim. That is why it is important that you work with a compassionate and capable workers’ compensation attorney that can answer your questions, and help you file your compensation claim. Speak to a skilled attorney that can advocate for you.

Requirements for Approval of a Workers’ Compensation Claim

In Colorado, the Division of Workers’ Compensation within the Department of Labor does not approve or deny claims. The workers’ compensation carrier (insurance company) decides whether they will admit or deny a claim. If it is denied and the injured worker challenges, it will be brought in front of an administrative law judge at a hearing and then it is the injured worker’s burden to prove by a preponderance of the evidence, or that it is more likely than not, that the injury is compensable.

Why Would Insurance Companies Deny a Claim

There are endless circumstances under which the denial of workers’ compensation claims in Denver occurs. Sometimes there is no valid reason and that can go into bad faith territory. A lot of times, there are some questions about that employer-employee relationship so the independent contractor argument comes in, otherwise, there is doubt as to the cause of injury and whether it may be pre-existing or whether it even happened at all if there is fraud involved. A lot of claims are denied because they do not believe it is of the course and scope of someone’s employment so it can be debatable. There are a lot of reasons a claim can be denied.

Reasons to Deny a Claim

The most common reasons for the denial of workers’ compensation claims in Denver, would be causation, attributing the injury to a pre-existing condition, or the lack of employer-employee relationship, and characterizing the injured worker as an independent contractor. Day laborers can also be an issue in the sense that if an employer picks up and an individual who is supposed to work with them for the day but that person is not an employee, they may not have grounds for a claim.

If a workers’ compensation carrier does not have the documentation to support it, they will deny it because there is a time limit once the claim has been filed with the state, they have to give an answer whether they are admitting or denying. Sometimes they will go into soft denial and allow conservative medical treatment because they are waiting on some medical records or for the employer’s first report of injury, they are just waiting on documentation but they will not do a hard denial, they will just softly deny it because they have to give an opinion or give a liability version.

Steps an Attorney Could Take

Most workers’ compensation attorneys would speak with the adjuster who has denied the claim and get a reasoning for that denial and hopefully it is an easy cure. Perhaps they are missing information or medical records, proving that an injury was sustained or some type of report or whatever they may need that is an easy cure. Otherwise, if it is a hard denial based on a legal issue, the workers’ compensation attorney can apply for a hearing in front of a judge and present a case and hopefully win that hearing to get it on an admission.

Things to Avoid to Ensure That Medical Treatment is Not Denied

The most important thing to keep in mind is that the injured worker should attend all their scheduled treatment appointments because treatment can eventually be denied due to non-compliance because they missed a certain number of appointments.

Injured workers should adhere to any restrictions that are given by their treating physician and understand that it is possible that the workers’ comp carrier will hire a company to perform surveillance. They will follow a person around and make sure they are not doing things that they say they cannot do or that they are not supposed to do.

If they are restricted from using their right arm altogether and then they see them throwing their five-year-old up in the air and playing, they are going to use that as evidence against them and can attack their credibility because they reportedly could not do that with their arm.

Issues of Invasion of Privacy

There are a lot of injured workers that have felt that their privacy is being invaded but the carriers have a lot of discretion. Essentially, they can surveil injured workers, but it should not be unnerving if they are doing the right thing and telling the truth. It does not happen in every case. For instance, if a female injured worker is being followed in the dark at night time by one man doing surveillance, they should take good enough precautions not to scare them. It should be handled in a more public manner.

How a Denver Workers’ Compensation Lawyer Can Help

Following the denial of workers’ compensation claims in Denver,  a workers’ compensation attorney can make sure to obtain a complete file. Anything that has happened previously on the case between you,  and the employer and the workers’ compensation carrier, whether that is medical records and bills, any type of reports, injury reports, or pleadings, should be in that file. Then the lawyer could file an application for a hearing on compensability and any other issues that need to be addressed whether that is average weekly wage or wage loss benefits. An experienced workers’ compensation lawyer could work tirelessly to build a positive outcome for you.

Gaiennie Law Office
3801 E. Florida Ave Suite 100
Denver
Colorado 80210
Phone: (303) 455-5030