After getting hurt at work, you may have expected a straightforward claims process. After all, the law generally requires that your employer carry workers’ compensation insurance to protect the company from liability and compensate you for any injuries sustained through the course of employment.
If the insurance company rejects your claim, you may feel frightened about paying your bills or affording your medical care. You may also feel frustrated about the potentially stressful bureaucratic process ahead. If you face a denial of your New Mexico workers’ compensation claim, you’ll likely need to consult with an attorney to discuss the situation and effectively evaluate your options.
What causes claim denials?
Every workers’ compensation claim is unique, but certain trends emerge when looking at denied or disputed claims. In some cases, employers assert that the worker may have sustained their injuries outside of the workplace.
Other times, there may be documentation that the medical issue is a pre-existing condition. In that scenario, you may need to gather enough medical evidence to prove that your job worsened your condition or caused a recurrence of symptoms that had previously diminished due to treatment.
Mistakes during the claims process, such as failing to report the injury to your employer, could lead to a denial. Allegations of injuring yourself on purpose or getting hurt due to intoxication while working could also justify the denial of an otherwise valid claim.
Finally, inadequate medical evidence or discrepancies between the information provided to your employer and your medical records could lead to claim denial. An attorney can help you understand the reason for the rejection of your claim and the process of filing an appeal.
Working with someone who has the time to actually interact with you on a face-to-face level is typically better than hiring an attorney who may communicate through a paralegal and never actually discuss the case with you personally.
What is the appeals process?
The appeals process requires that you act promptly. You usually only have 30 days to file a complaint with the New Mexico Workers’ Compensation Administration (WCA). After you file your complaint, you typically need to attend mediation to resolve the matter amicably.
If mediation is not successful, then you may need to attend a formal hearing in front of a judge. At that hearing, your attorney can present evidence about your injury and even question witnesses about the incident on the job or your medical condition. The process can be overwhelming for those trying to negotiate with the WCA in Albuquerque.
An attorney can help you understand the rules that apply during an appeal. They can advocate for you and help you secure the benefits the insurance company attempted to deny you. Sitting down to discuss a denial notice with a workers’ compensation attorney as soon as possible can help you take appropriate steps to pursue the benefits you need.