According to -, employees in Delaware who are injured on the job or who may suffer from health conditions due to their work such as repetitive strain injuries or lung damage due to continuous exposure to dangerous chemicals are eligible to claim for worker’s comp benefits. In this article, we spell out procedures for pursuing a work comp claim in Delaware. Delaware has elaborate laws and statutes guiding the process of claiming for worker’s compensation benefits by injured employees while in the course of duty.
What to Do Immediately After an Accident
Immediately after the accident or on noticing your condition, you need to file a notice with your employer. Where you sustain an injury on the job, such a notice should be filed within 14 days. Your employer or insurance company will require you to attach or follow it up with evidence from a certified medical doctor in order to process your claim. Chances are you are going to get the benefits, especially if you have followed all the procedures. However, you may also be denied your benefits if you fail to meet the legal requirements.
What Might Cause the Denial of My Claim?
Everybody, including your employer or its insurance administrator, would want to minimize their yearly claims in order to improve their overall bottom line. Therefore, they always look for all possible ways to deny workers’ compensation claims. Nevertheless, whatever the reason they rely on should be reasonable and anchored in law to warrant a denial of benefits to an injured employee.
Below are some of the reasons that insurance companies may use to deny you compensation:
Missed Deadlines
The law requires that an injured employee should report the injuries immediately after which you are required to file your workers’ compensation claim with Delaware state agency. In some cases, employers or insurance companies might take up the matter once the employee notifies them of the injuries.
Your Employer Successfully Disputes Your Injuries
If your employer proves that you weren’t on duty at the time of the accident or that your health condition did not arise out of a work-related accident, you may be denied your claims. In this case, you will need to provide evidence such as witnesses to provide an account of the accident. You might need to ask your medical doctor to provide his or her findings that attribute your current medical condition to your work. If the insurance company objects the medical report, you may need to have an independent examination or opinion of another medical practitioner. In some cases, your condition may fail to meet the minimum threshold of severity defined under the law.
What You Should Do If Your Claim Is Denied
Although it comes with pain, it is ordinary that your claim may be denied the reasons for the denial notwithstanding. If this happens, you need to study the letter keenly to understand the basis of the decision. If you believe the denial was not warranted or that it was due to a few errors in the paperwork you might want to contact a claims adjuster to help you correct the mistake. This may only work if it is your employer’s mistake or that of the insurance company and that they admit the error. If this is not the case, you will be required to consider filing an appeal with the help of a workers’ compensation lawyer, such as -.
How to Appeal a Workers’ Compensation Claim Denial
You will be required to appear for a hearing before the administrative judge. It is at this point that you will present all your material evidence. Different levels of appeal exist with the administrative level being the primary level of appeal.
When Should You Hire a Lawyer?
Pursuing a workers’ compensation claim after it has been denied can be an uphill task. Unless the denial was because of simple mistakes that can be cleared up, it is advisable to talk to a lawyer with experience in Delaware workers’ compensation law. You need to hurry and file your appeal immediately as the timelines are usually very short. Appeals are extremely complicated and filing it yourself may be challenging. The processes follow the ordinary rules of civil procedure and evidence thus only a knowledgeable lawyer would be able to handle an appeal. Remember that an appeal is such a delicate matter and you need to have a highly experienced workers’ comp attorney by your side,-, to increase your chances of winning the case.
