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What to do if the insurer denies your workers’ compensation claim

On Behalf of | Sep 10, 2021 | Workers' Compensation |

Employers in Minnesota must have insurance to compensate the workers who get injured on the job. This insurance pays for the worker’s medical expenses, lost wages and vocational rehabilitation. Every worker has the right to ask for these benefits when they get hurt while performing their duties. However, the insurer can deny their rightful claims for different reasons. If this happened to you, there are several things you can do to fix the problem. Ultimately, you can appeal the insurer’s decision by filing a claim.

Talk to the claims adjuster

The first thing you should do is to talk to the claims adjuster of your employer’s insurer. Try to explain the problem to them and tell them the reasons why you deserve your benefits. Sometimes, workers can fix the problem with just a single call. However, if that does not work, you can reach out to an Alternative Dispute Resolution (ADR) specialist.

Seek an ADR specialist’s help

ADR is the procedure for solving disputes without having to go to court. In ADR, a neutral third party can act as a mediator between you and the insurer to resolve the problem with the claim. You can find a specialist in ADR at the Department of Labor and Industry (DLI). The specialist will try to resolve your problem, but sometimes this is not possible through ADR. If the problem persists, you will need to file a claim petition.

File a claim

Once you file the Employee’s Claim Petition form, you will begin a formal litigation process. If you decide to do this, you should consider seeking an attorney’s help, as the process of litigation involves complicated legal matters. After filing, a judge of the Office of Administrative Hearings (OAH) will take your case. However, the insurer may offer you a settlement during a conference or mediation session before a hearing. Accepting a settlement means that the insurer will give you a specific sum of money if you give up your rights to your benefits in return. If you don’t accept the settlement, your case will go to trial. The judge will listen to your arguments and decide whether you have the right to compensation or not. You can also appeal the judge’s decision at the Worker’s Compensation Court of Appeals if you disagree with it.

Your right as a worker

You must keep in mind that if you are a construction worker or union member, the process of appealing a denial is different. Otherwise, you can take mentioned steps to solve the dispute between you and the insurer. You deserve compensation for your injuries, and you have the right to fight for it in court.