Can I Sue My Employer for Denying Workers’ Comp?

Employees who suffer injuries or develop medical conditions at work, such as lung disease or cumulative trauma, are often eligible for workers’ compensation in Des Moines, IA. However, what can the victim do if their employer or insurance company denies the claim? Can they sue their employer? Do they need to hire a Des Moines workers comp attorney?

An employee’s course of action depends on the reasons for the denial. The workers’ comp system works by allowing employees to receive benefits without proving negligence. In exchange, they can’t sue or file lawsuits 

against employers for work injuries.

If the employer denied the claim with a valid legal reason, the victim’s only recourse might be an appeal. This page describes the reasons why employers deny claims and the steps employees could take.

Employer That Denied Your Claim

What Are the Reasons Employers Deny Workers’ Comp Claims?

Insurance companies and employers often search for any possible means to deny a workers’ compensation claim. However, they only do it if the reason is valid under the law. Some common reasons for why employers might deny claims are:

The Employee Missed the Deadline

Victims looking to receive workers’ compensation benefits need to report their ailment or injury as soon as it happens. For cases of workers’ compensation in Des Moines, IA, employees have up to 90 days to inform their employer that they sustained an injury.

If the victim misses this deadline, the employer might deny the claim. In some states, failing to report an injury doesn’t merit a denial as long as the boss is aware that the incident occurred. Regardless, it’s essential to file the claim on time. 

The Injury Isn’t Work-Related

Occasionally, employers might dispute whether their employees’ injuries occurred while they were at work. They might argue that the victim was misbehaving or that the health condition didn’t develop due to a work accident or exposure.

It’s crucial to gather evidence supporting the workers’ compensation claim. Eyewitness accounts might be helpful, as is having medical evidence. If the treating doctor attributed the condition to work, but the insurance company continues to disagree, the victim may have to get an independent medical examination to get another opinion.

The Employees Injuries Aren’t Severe Enough 

Workers’ comp benefits victims with severe injuries that require time off from work and medical treatment. Employees might have delayed injuries or chronic conditions that allow them to continue working in some cases, even if they’re enduring some impairment or pain. 

In these scenarios, the insurance company or employee might challenge the claim’s severity and deny coverage. Employees who wish to avoid this should immediately report their injuries to their employers after suffering them and get treated.

The Victim Left the Job or Was Laid-Off 

Insurers and employers deny claims that employees filed after being laid off or quitting. However, there are some exceptions to the rule. Victims are eligible for workers’ compensation in Des Moines, IA, if the injury occurred after receiving the termination notice but before their last day.  

Having medical records of the injury proving that it occurred before termination also allows employees to file a claim. Should a person qualify for these exceptions, they might be able to contest the denial.

Work Injury Claim Denied

What Should You Do When Employers Deny Your Claim?

Employees shouldn’t give up their benefits because of their claim’s denial, but they shouldn’t act rashly either. The first step is to look at the mandatory letter that informs the employee of the denial, which should describe the reasons for it. 

If the victim feels that it was simply a mistake, they can consider contacting the insurance claim agent to check whether it’s a solvable problem. However, this route rarely leads to a successful result unless the employer or insurance company makes a tremendous mistake and acknowledges it. 

The typical course of action is to appeal the denial of the workers’ compensation in Des Moines, IA. This process involves filing a contested case petition with Iowa’s workers’ compensation commissioner and sending a copy to the insurance company. Once the commissioner receives the petition, they give the case to a deputy commissioner. 

Afterward, the victim and insurance company can agree on a hearing date, where they submit legal evidence and arguments that support their positions. The deputy commissioner then reviews the evidence and emails the decision.

Bottom Line

There are several reasons why employers might deny a workers comp for an employee. If there is a valid legal reason, a victim’s only option might be to file an appeal for the denial. Sometimes, the insurers, employers, and employees settle the issue quickly, but it can proceed to a hearing with a deputy commissioner on other occasions.