What if My Workers’ Compensation Claim is Denied?

In Nebraska, employees who become injured or suffer illnesses in a workplace incident may recover benefits – medical expenses and lost wages – through a workers' compensation claim. However, your workers' comp claim may be denied or benefits terminated or suspended.

If this occurs, you may be eligible to file an appeal to preserve your rights. An experienced Nebraska workers' compensation attorney can enlighten you about your available legal options if your workers' compensation claim is denied.

At Harris & Associates, P.C., L.L.O., we are poised and ready to assist, guide, and represent clients whose workers' compensation claims have been wrongfully denied. As your legal counsel, we can evaluate the reason your workers' comp claims were denied and explore your possible legal options to proceed.

Additionally, our attorneys will fight compassionately for your appeal rights, walk you through every legal step in the workers’ compensation appeal process, and help you recover your deserved benefits. We're proud to serve clients across Omaha, Nebraska, and surrounding counties, including Sarpy, Douglas, Lancaster, and Dodge County.

Reasons a Workers' Compensation Claim May Be Denied

According to the most recent study by Lockton Companies, between 2013 and 2017, workers’ compensation claim denial rates increased from 5.8% to 6.9%. Workers' compensation claims may be denied due to several reasons, including:

Failure to Report Your Injury On-Time: In Nebraska, employees involved in workplace accidents must report their injuries to the employer as soon as possible. If you delay, the insurance provider might deny your claims.

Injury Wasn't Work-Related: Your workers' comp benefits may be denied if your injuries or illness were caused by an unrelated incident or while involved in horseplay at work.

Intoxication or Drug-Related Violation: If you were intoxicated or under the influence of drugs or alcohol when the incident occurred, your workers' compensation claims may be denied.

Failure to Receive Adequate Medical Treatment: Also, if there are no medical records or supporting documentation to show that you were treated for an injury or illness, you won't have any document to support your workers' compensation claims. Hence, your benefits may be denied.

Failure to File Your Claims On-Time: Under Nebraska laws, the time limit for filing a workers' compensation claim is two (2) years from the date of the injury. Failing to file your claims within this period may result in a denial.

Others: Some other common reasons for workers' compensation claims denial include:

  • Your injury or illness is from a pre-existing medical condition.
  • There are no witnesses or video surveillance footage to serve as evidence for your injury.
  • Your employer disputes your workers' compensation claims.
  • Your claims require further investigation.
  • Misrepresentation
  • Your injury was caused by your negligent actions or carelessness
  • You weren't treated by an approved physician.

If your employer or insurance provider denies your claim, you will receive a "Notice of Controversion of Right to Compensation." A skilled attorney can evaluate the surrounding circumstances of your unique situation and help appeal your workers’ compensation denial in a timely manner.

Notice of Controversion

A "Notice of Controversion" can be described as the denial of a workers' compensation claim – filed by an injured employee – under the Defense Base Act. If your employer disputes your workers' compensation claim, they will petition a Notice of Controversion stating the reasons for the denial. An experienced workers' compensation attorney can review the reasons for denial thoroughly and gather substantial evidence and documents to appeal the decisions.

Appealing the Decision

To appeal the decision of the workers' compensation court, you must file a Notice of Appeal document in the office of the court clerk within 30 days of receiving the judge's decision. A skilled lawyer can walk you through the appeal process, attempt to get the previous decision overturned, and help recover your deserved workers' compensation benefits.

Seek Legal Guidance from a Skilled Workers' Compensation Attorney

Filing for workers' compensation claims often involves several complex processes. Unfortunately, your legitimate claims may be denied due to a different number of reasons. Regardless, you should never despair. You can appeal the denial of the claim by providing factual evidence and documentation that your claims are valid under Nebraska state laws. An experienced workers' compensation attorney can fight diligently to protect your appeal rights and help present a strong case for your benefits.

At Harris & Associates, P.C., L.L.O., we have the expertise, resources, and diligence to guide and represent clients in workers' compensation claims denial matters. Our trusted attorneys can review the reasons for your benefits denial and craft an effective strategy to file an appeal.If you received an initial workers' compensation claims denial, don't lose hope. Contact Harris & Associates, P.C., L.L.O. today to schedule a simple case evaluation with skilled workers' compensation lawyers. Our trusted legal team has the personalized legal guidance, support, and vigorous representation you need in your appeal. We proudly serve clients across Omaha, Nebraska, and surrounding counties, including Sarpy, Douglas, Lancaster, and Dodge County.


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