You were injured on the job and followed all the rules: reported your injury right away, saw an approved doctor, and submitted your workers' comp paperwork on time. So why did you just receive a denial letter from your employer's insurance company?
Receiving a rejected Virginia workers' compensation claim is a frustrating, stressful, and all-too-common scenario. While employers and insurers are supposed to honor legitimate claims without hassle, the reality is that they frequently try to avoid paying by unfairly denying claims for flimsy or false reasons.
The experienced workers' compensation attorneys at Dulaney, Lauer & Thomas know how a denied claim can devastate an injured worker's health, finances, and future. However, our legal team has seen countless people successfully appeal denials and secure the medical treatment and wage loss benefits they desperately need and legally deserve.
If your Virginia workers' comp claim has been rejected, don't lose hope. You still have powerful legal rights and options to fight for the benefits you're owed. Let's break down the most frequent reasons claims get denied and how you can avoid the insurance company's traps with strategic support.
Top Reasons for Workers' Comp Denials in Virginia
While no two claims are exactly alike, insurance companies tend to rely on the same playbook of denial rationales over and over again. Understanding these common rejection reasons can help you sidestep potential pitfalls in your own case:
- Missed deadlines for reporting the injury or filing the claim
- Discrepancies in the accident description or injury circumstances
- Allegations that the injury is not work-related
- Disputes over the severity of the injury or the need for treatment
- Failure to attend an "independent" medical exam with the insurer's doctor
- Accusations of intentional injury, horseplay, or intoxication
Spotting these red flags early and knowing how to counter them with the proper evidence and arguments can increase your chances of getting your claim approved from the start.
How to Handle a Virginia Workers' Comp Denial
If your claim is denied, don't panic and don't give up. Virginia law provides a robust appeals process for challenging wrongful claim rejections and demanding the benefits you deserve. Key steps include:
- File an Employee's Claim Form. You have one year from the date of your injury (or last temporary total disability payment) to submit this form to the Virginia Workers' Compensation Commission (VWC). This is a critical deadline you cannot miss.
- Request a hearing. After you file the claim form, the VWC will give your employer's insurer 20 days to respond. If they don't reverse their denial, you can request a hearing before a Deputy Commissioner to present your case.
- Gather evidence. To win your appeal, you'll need compelling medical evidence linking your injury to your job and showing the extent of your disability. Request a copy of your claim file from the insurer. Get detailed work status notes from your doctor. Keep a daily log of your symptoms and limitations.
- Prepare for your hearing. At the hearing, you'll testify about your accident, injuries, and disability. Your attorney will cross-examine the insurer's witnesses and present your medical records. The Deputy Commissioner will review the evidence and mail a written decision.
- Plan for further appeals. If you disagree with the Deputy Commissioner's decision, you can appeal to the full Commission for a review. From there, appeals are heard by the Virginia Court of Appeals and the Supreme Court of Virginia.
Many workers find the appeals process intimidating or confusing to navigate on their own. But an experienced workers' comp attorney can guide you through each stage, help you build the strongest possible case, and fight for your rights before the Commission.
Don't Let a Denied Claim Derail Your Recovery
A rejected workers' comp claim is a significant setback, but it doesn't have to be the final word. With the right strategies and support, you can appeal the insurance company's decision and get the medical care and financial stability you need to heal and move forward.
At Dulaney, Lauer & Thomas, we've helped countless workers across Virginia overturn unfair claim denials and secure the full compensation they're entitled to under the law. If you're facing a denial or other workers' comp dispute, don't go it alone. Let us put our deep legal knowledge, proven negotiation skills, and fierce courtroom advocacy to work for you. Together, we'll develop a tailored plan to fight for your claim and your future.