If an insurance company denies your claim, you certainly can fight the denial. To do so, you can do it on your own or hire an attorney.
More often than not, hiring an attorney is advantageous because the attorney, if you hire the right one, knows what they are doing and will be much more effective than you handling the case yourself.
Denials can fall into two baskets.
- Sound denials. Sound denials will require strong evidence to overturn. An example of a sound denial would be if you work for an employer for three months doing repetitive assembly-line work and start having low-back issues, but you've had 10 years of chronic low-back issues and treat with a chiropractor weekly. Establishing that you have a new injury and/or damage to your back due to the three-month job may be difficult. An excellent medical expert might push you over the top and allow you to win the case. The expert might need to identify new damage in your spine via an MRI, CT scan, or other objective test.
- Weak denials. Another type of denial is a weak denial. Our firm sees a ton of weak denials. A weak denial would be where the insurance company denies your claim for a variety of bogus reasons, including late reporting, inconsistent statements, or lack of an accident. Ultimately, if a denial is weak, our firm will want to see your medical records. If your records support that you were hurt at work, and/or if you have strong witnesses, your chances of getting the denial overturned are much stronger.
In most cases, but not all, the content of your medical records will make or break your case if your claim is denied. When a potential client contacts our firm and says their claim is denied, in most situations, we like to see the initial medical records stemming from the accident, especially if the worker sought treatment right away. If those records support the accident, the claim is likely much stronger. However, if the initial medical records say something like, "Patient is here for chronic back pain for 10 years, no known accident..." that may be a stronger denial.
If you need help with a denied claim, please contact the attorneys at Klezmer Maudlin. We handle cases throughout Indiana, have over 100 combined years of experience and have handled over 50,000 claims. Finally, we wrote the book on workers' compensation: the Indiana Practice Manual on Workers' Compensation.