Vermont Denied Workers’ Comp Claim Lawyer

Employers don’t like workers’ compensation claims; it raises their insurance premiums. The insurance companies don’t like to pay claims either; it hurts their bottom line. You can expect both your employer and the workers’ comp claims adjuster to take a hard look at your claim and deny it if they can. Vermont workers’ compensation law puts the burden on the employee to prove they suffered a work injury. This task requires submitting evidence to support your claim, and your employer might submit contrary evidence; your evidence must outweigh theirs, or your claim can get denied.

When the employer is challenging your claim and bringing in contrary evidence, or the claims adjuster is turning down your claim for one reason or another, having a skilled and experienced workers’ compensation attorney on your side can make the difference as to whether your claim gets accepted or denied. Vermont workers’ compensation attorney Justin Sluka has over a dozen years of experience representing employers and insurance companies, as well as many years representing injured workers. We know how and why claims get challenged or denied and what to do about it when they do.

Below are some of the most common reasons workers’ compensation claims get denied. If you are having trouble getting workers’ comp after an injury on the job, call Sluka Law for a free consultation and help from a dedicated and effective Vermont denied workers’ comp claim lawyer.

The application is not timely

Vermont workers’ compensation law requires you to report a work injury as soon as it happens. In the case of a repetitive use injury, you must report the injury as soon as you are aware of it. From the date of the accident or onset of injury, you have six months to file a claim. If you miss this deadline, your claim can be denied. If you wait too long to report the injury or seek medical treatment, it gives the other side ammunition to claim your injury is not work-related or isn’t real.

The application is incomplete

To get the ball rolling on your claim, you need to complete and file Form 5 – Employee’s Notice of Injury and Claim for Compensation. This form isn’t very long, but it’s an essential component of your claim, and it must be filed completely and accurately. The form will ask specific questions about the accident and injury that you must answer. You will also need to submit supporting documentation, including medical records, treatment notes, ER or radiology records if applicable, and notes from various providers treating you, such as physical therapists. Although not required, it is strongly recommended to include notes from the doctor giving an opinion that the injury is work-related. Witness statements, if available, should also be included.

Any missing, weak, inaccurate, confusing or contradictory information on Form 5 can unnecessarily delay your claim or lead to a denial.

The injury is not work-related

Workers’ compensation only pays for injuries that arose out of and in the course of employment. Unless you have strong documentation proving your claim, expect the employer and insurance carrier to say your injury happened in some other way, such as at home or while playing sports, or that it occurred while you were off the clock or outside of the workplace.

The injury is pre-existing

This is a very common reason to turn down your claim, and depending on the injury, it can be difficult to prove your case. Proving that a work accident occurred before you sought medical treatment is strong evidence the injury is work-related. Also, even if you had a pre-existing injury, any aggravation of that injury at work is compensable. If the pre-existing condition comes from a prior work injury, either your current or former employer is responsible to pay your workers’ comp benefits.

You aren’t really injured

Insurers often believe workers exaggerate or fake workers’ compensation claims in order to get out of work and collect benefits. As insulting as it is to be accused of faking an injury, the burden still lies with you to prove your injury and that it was work-related. We can help you fight back against allegations like these and prove your case.

Other common reasons for denial

Vermont workers’ compensation law and the Department of Labor specifically note the following as reasons carriers can deny claims:

Your injury was caused through a willful intent to injure yourself or another
You were intoxicated at the time the injury occurred
The injury is attributable to your failure to use a safety appliance that was provided to you

The insurer might also accept your claim but deny your treatment plan, such as surgery. The burden is on you to prove a particular treatment is reasonable and necessary.

The insurer might also accept your claim but stop paying lost time benefits when you reach a “medical end result.” The burden is on the carrier to prove this has occurred. If you think your benefits are being cut short, Sluka Law can help.

Serving Injured Workers Throughout Vermont

Get Help With Your Vermont Workers’ Compensation Claim Denial

If your claim for workers’ compensation has been rejected, there are steps you can take to appeal that denial and get the benefits you need and deserve. At Sluka Law, this is all we do. For help throughout the state of Vermont, call 802-457-1000 for a free consultation. We can handle your case through phone and video calls wherever you are in the state, and we only charge a fee after we are successful in winning workers’ compensation for you.

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