What To Do If Your Missouri Workers’ Compensation Claim Is Denied

If you were injured at work but your workers’ compensation claim was denied, you may feel panic, anger, frustration – and fear. It’s hard enough to file the initial claim. How are you supposed to fight a denial?

Because your employer and the insurance companies providing workers’ comp coverage have their own legal teams, you should have a lawyer on your side, as well. At Schuchat, Cook & Werner, our firm has a 75-year history of protecting worker rights, including the right to receive workers’ compensation. We’ve worked with clients who are employees (union members or not) in the St. Louis metro area, including those in southern Illinois. We’re a mission-driven firm where your recovery is the priority – not our billable rate. Our team is experienced and ready to fight for the benefits and income you need to move on from difficult workplace injuries.

If you’re facing a workers’ comp denied claim, call our office in St. Louis at 314-621-2626 or toll-free at 888-365-0445, or fill out our online intake form to schedule an appointment. 

Why Workers’ Comp Claims Are Denied

You may feel you did everything right when you filled out your claim. However, there are many reasons that your employer or the workers’ comp insurer may reject the claim, including:

• Your employer may claim the injury was not work related.
• Your employer may assert that the injury occurred because of roughhousing or horseplay.
• Your employer may insist you were a contractor, not an employee, and therefore not eligible for workers’ comp.
• The insurer may claim your injury is related to a pre-existing condition.
• The insurer may insist you see an Independent Medical Examination doctor for an evaluation, and their report may conflict with your treating physician’s assessment of your injuries.
• The insurer may claim your workers’ comp treatments are not “medically necessary.”
• The insurer may cancel your benefits due to missed appointments or incomplete paperwork.

Another significant reason for claim denials is missing the state’s 30-day window for reporting the accident causing your injuries. The Missouri Department of Labor & Industrial Relations requires you to submit a written report of the accident to your employer within 30 days, and it must state the date, time and place of the injury, the nature of the injury and the name and address of the person injured.

This 30-day window may be extended if your employer had direct knowledge of your injury – for example, if they saw it happen. This reporting window is different from the deadline to submit a workers’ compensation claim. You have two years from the date of the injury to file your claim with the state.

Steps To Take After A Denied Workers’ Comp Claim

You may feel defeated after a workers’ comp claim denial, but what you do next can determine whether you will be able to appeal the denial. Specifically, you need to:

1. Request a written copy of the denial and the reasoning behind it.
2. Document your symptoms and work restrictions.
3. Maintain an accurate written timeline of the injury, including the date of the injury, when treatment was given and the date you made the initial report.
4. Track your mileage to and from appointments, the cost of prescriptions (and what medicines) and any other out-of-pocket costs you incur.
5. Attend all scheduled medical appointments and follow your doctor’s instructions.

Our attorneys can help you prepare your denied claim appeal. They are also available if you are asked to make any recorded statements about your claim. It’s important you avoid recording statements about your workplace injuries without counsel present – the insurer may use those statements to dismiss the severity of your injury and block your appeal.

Understanding The Workers’ Compensation Appeals Process

Appealing a workers’ compensation claim decision you don’t agree with is a multiphase process. Your first step after a claim denial is requesting a Pre-Hearing Conference or Mediation with an administrative law judge (ALJ) to attempt to resolve the dispute before moving to a formal evidentiary hearing. If that is unsuccessful, next comes an evidentiary hearing before an ALJ with the state’s Division of Workers’ Compensation. If you dispute the decision of the ALJ, you have 20 days to file an Application For Review from the Missouri Labor and Industrial Relations Commission (LIRC). The commission will evaluate your case and announce its decision.

If you want to take your appeal above the LIRC level, you have 30 days to file an appeal with the Missouri Court of Appeals. Appellate court decisions can be appealed to the Missouri Supreme Court.

At the ALJ and LIRC appeal levels, the facts of your case will be what your attorney submits as evidence, including your medical records, the reports of witnesses and documentation of reduced job duties. When your claim reaches the Missouri court system, the focus of the case will shift to questions of errors in the law related to your claim denial.

Our attorneys have handled appeals at all levels of the workers’ comp system and understand how to create strategies encouraging a positive outcome. They also have negotiated settlements with workers’ comp insurers when that is the best course of action.

Answers To Common Questions About Denied Workers’ Comp Claims

Knowing the law about workers’ comp claim denials can lower your worry and stress levels. Here are answers to three frequently asked questions that our attorneys hear in our offices.

Can I be fired if I file a workers’ comp claim and it’s denied?

No. Missouri law protects workers who file workers’ compensation claims from retaliation, including being fired for getting injured or filing a claim. However, your employer may still fire you for reasons unrelated to your claim, such as company-wide layoffs, poor performance or violating company policy.

Can I make my employer pay for a denied medical visit?

The short answer is no, not immediately. If your claim is denied, the insurer will refuse to pay your medical bills upfront, including:

• Emergency room visits
• Imaging appointments, including MRIs
• Surgery related to your injury
• Physical therapy
• Referrals to specialists for additional treatment

You must pay or use personal insurance and then seek reimbursement later if you win your appeal.

Can I settle a denied workers’ compensation claim?

Yes, you have several opportunities to enter into settlement negotiations to resolve your claim. The state’s Division of Workers’ Compensation offers a voluntary Dispute Management Unit to assist parties in mediating early disputes over medical treatment or lost wages, provided a formal Claim for Compensation has not yet been filed.

Additionally, an attorney can help you negotiate a lump-sum or ongoing settlement at any stage of the appeals process. It’s critical that your lawyer carefully examine any settlement offer and advise you on how it could impact you in the future.

Let Us Fight Your Denied Workers’ Comp Claim Battle For You

After a workplace accident, your primary job should be to heal, not fight for the compensation and benefits you need to do that. Our firm’s attorneys will fight for a decision on appeal that keeps you on the road to recovery. Call our office at 314-621-2626 or toll-free at 888-365-0445 to schedule a free initial consultation. You may also use our online contact form to get started.