Employees in Wilmington and nearby Delaware locations often take for granted that workers’ compensation can pay for their losses. If they get hurt at work or diagnosed with a medical issue directly caused by their work responsibilities, they expect to receive medical coverage for their care costs and possibly disability benefits if they miss work or must perform lower-paid job functions during their recovery.
A denied workers’ compensation claim can leave a Dover-area professional without income and struggling to pay for their treatment expenses. How can workers appeal an unfavorable decision to pursue the workers’ compensation benefits they need?
Common reasons for denials
A successful appeal requires an understanding of the reason for the denial. Providing late notice of an injury or diagnosis to an employer can lead to a denied claim. Employers or insurance providers may dispute whether the condition actually relates to the professional’s employment. Pre-existing conditions, missed paperwork deadlines and inadequate medical proof are also common reasons for claim denials.
How to appeal in Delaware
After reading the Delaware workers’ compensation denial letter to determine the cause, the worker should continue receiving the care outlined by their physician. They can then correct issues with their paperwork and gather evidence. An incident report from their employer, statements from witnesses and medical records can help connect an injury to employment.
The formal Delaware workers’ compensation appeals process begins with the submission of a Petition to Determine Compensation Due to the Industrial Accident Board. Workers may need to attend mediation sessions and hearings. They may need to work with medical experts to validate the origin and extent of their condition.
What to do after an injury
Typically, injured Delaware professionals must report a workplace injury to their employer within 90 days or a diagnosis within 6 months. They have up to two years from the date of injury to file a workers’ compensation claim and up to five years from the date of their last benefit payment to request additional benefits.
Injured workers may struggle to navigate a workers’ compensation claim on their own behalf, and an appeal is even more of a challenge. Working with an experienced Delaware workers’ compensation attorney can reduce the likelihood of a rejected claim and make the appeals process more accessible. The sooner that workers in Newark or nearby locations secure legal guidance, the better their chances of getting benefits before their financial challenges worsen.