You dutifully reported your workplace injury and filed a workers’ compensation claim, only to receive the devastating news that your claim has been denied. Where do you turn now?
Denial of a workers’ compensation claim is not uncommon in Tennessee, but it does not mean the end of the road. You have the right to appeal the decision and fight for the benefits you deserve.
A Knoxville workers’ compensation lawyer can guide you through the appeals process, ensuring that you meet all deadlines and provide the necessary evidence to strengthen your case.
Why Would a Workers’ Comp Claim Be Denied?
Insurance companies and employers regularly deny legitimate workers’ compensation claims for various reasons. Understanding why your claim was denied is an important first step; with this information, you can begin mounting a successful appeal for the benefits you deserve.
Some of the most common reasons for denial include:
- Missed Deadlines: Many injured workers lose their right to compensation simply because they waited too long to take action. Tennessee law requires you to file your formal claim within one year. If you miss this deadline, even by a single day, the insurance company can automatically deny your claim regardless of its merit.
- Insufficient Medical Documentation: Your medical records must clearly demonstrate that your injury occurred due to a workplace incident or conditions. If your records lack specific details about how the injury happened, fail to connect it directly to your job duties, or show gaps in treatment, the insurance company will likely deny your claim.
- Pre-Existing Conditions: Insurance companies frequently deny claims by arguing that your current injury stems from a previous condition rather than a workplace incident. For example, if you had prior back problems and suffered a work-related back injury, the insurer might claim your pain comes from your pre-existing condition.
- Disputed Accident Location: Your injury must occur within the scope of your employment for workers’ compensation to cover it. Insurance companies often deny claims by arguing you weren’t technically “on the job” when the injury happened.
How to Appeal a Workers’ Compensation Decision
In Tennessee, if your workers’ compensation claim is denied, you have the right to appeal the decision. You will need to file a Petition for Benefit Determination with the Tennessee Bureau of Workers’ Compensation. This petition initiates the appeals process and triggers a mediation conference where you can present evidence supporting your claim.
If the mediation conference fails to resolve your dispute, your case moves to a compensation hearing before an administrative judge. The judge reviews all evidence and testimony before making a final determination about your benefits.
How a Workers’ Compensation Lawyer in Knoxville Can Protect You
When appealing a workers’ comp decision, it is essential to have an attorney on your side. A workers’ compensation lawyer understands Tennessee’s labor laws and the tactics that insurance companies use to deny valid claims. Your attorney will serve as your advocate throughout the appeals process—gathering evidence, interviewing witnesses, and aggressively challenging the insurance company’s reasons for denial.
Your attorney will handle all communication with insurance adjusters, protecting your rights throughout the process. They will also prepare your case for mediation and, if necessary, present compelling arguments before an administrative law judge.
For years, The Lawyers of Brown & Roberto has fought for injured workers throughout Tennessee, successfully overturning claim denials and securing fair compensation. We can fight for the benefits you deserve. Contact us at (865) 691-2777 today for a free consultation with our Knoxville workers’ compensation attorneys.