Workers’ Compensation Denials in Springfield, MO

Workers' compensation is a critical resource for employees who suffer work-related injuries or illnesses. However, not all claims are accepted, and denials can be a significant hurdle for those seeking support while they recover from their injuries or learn to live with lasting limitations.

At Aaron Sachs & Associates, P.C., our award-winning workers’ compensation team helps clients across Springfield and the state of Missouri craft custom-tailored solutions after being denied the benefits they deserve. From helping folks understand why their claims were denied to providing guidance through the Missouri workers’ compensation appeals process, we provide the step-by-step support workers and families need to secure positive outcomes. 

If you have questions about a recent denial and how we can help, the time to act is now. Missouri law has strict deadlines when it comes to requesting appeals and other proceedings in workers’ compensation cases and bringing your matter to the attention of an experienced lawyer as soon as possible can help preserve your right to recover benefits. 

Our workers’ compensation at Aaron Sachs & Associates, P.C. is standing by to help. Call (888) 287-1046 or contact us online for a FREE consultation.

Common Reasons for Workers' Compensation Denials in Missouri

Workers and families filing for workers' compensation benefits in Missouri may encounter several stumbling blocks that can result in claim denials. Some of the most common issues involve:

• Timeframe Non-Compliance: Timely reporting of an injury to your employer is essential and required by law. In Missouri, waiting too long to report can jeopardize a claim.
• Medical Evidence: A successful claim must have medical documentation that supports the extent of the injury and its relation to workplace activity. Without sufficient evidence, insurers may deny claims or deny the full scope of benefits to which workers are entitled.
• Work-Related Injuries: Claims often hinge on the location and circumstances in which the injury occurred. If an injury is not clearly work-related, workers’ compensation insurers may use that to argue that it must be denied. 
• Employer Disputes: Sometimes, employers challenge a claim based on findings from their investigations, leading to a denial. They may argue that workers engaged in prohibited or unlawful activities leading up to the injury or allege that other deniable conditions existed.
• Non-adherence to Treatment: A worker’s adherence to medical advice and prescribed treatments plays a role in the legitimacy of your claim. Some denials can stem from allegations that workers failed to appropriately treat injuries. 
• Post-Termination Claims: Claims filed after an employee has been terminated or laid off are viewed with suspicion and often denied by workers’ compensation insurers. 
• Employee Misconduct: If the injury resulted from non-compliance with safety measures, willful misconduct, or intoxication, the claim is likely to be denied.

The Appeal Process in Missouri for Denied Claims

If your workers’ compensation claim was denied in Missouri, you may have options for recourse. 

This includes evaluating any administrative or clerical errors that may have impacted the decision made by your employer’s workers’ compensation insurance carrier and rectifying them promptly. When claims are denied entirely or when you have been denied certain benefits to which you believe you are entitled, you may also have grounds to pursue an appeal. Generally, the appeals process will involve:

1. Filing a Claim: The first step post-denial is to file a claim with the Missouri Division of Workers’ Compensation within the legally stipulated window.
2. Mediation Attempt: Opting for mediation could lead to a settlement, with facilitation by an impartial mediator in an informal setting.
3. Formal Court Hearing: In the absence of a settlement, a formal hearing before an administrative law judge is the next arena for disputes.
4. Commission Review: A decision by the administrative law judge can itself be appealed to the Labor and Industrial Relations Commission, which will evaluate cases for any errors committed by the ALJ and issue decisions. 
5. Judicial Appeal: Persistent disagreements can escalate to the Missouri Court of Appeals for a review based on legal adherence and evidentiary support. This is typically the final stage of an appeal, although a select number of cases may be taken up for consideration by the Missouri Supreme Court, which is the official last level of appeal. 

Aaron Sachs & Associates, P.C. has decades of collective experience helping workers and families file workers’ compensation appeals and can evaluate your options following a denial as soon as you reach out for help.

Workers’ Compensation Denials & Independent Contractors

The status of a worker as an independent contractor or employee plays a significant role in workers’ compensation eligibility in Missouri. 

Unlike employees, independent contractors are not typically covered under workers' compensation and must often rely on personal insurance or litigation after an injury. Understanding this distinction is crucial since misclassification can affect your rights and obligations under workers’ compensation law.

If you were denied benefits on grounds that you were an independent contractor and not a bona fide employee, our team can evaluate your options for challenging your employment classification or seeking benefits through other legal avenues, such as a personal injury claim. 

Learn More About Your Options After Being Denied Workers’ Compensation in Springfield, MO

While workers' compensation is a safety net for many, navigating the process can be complex, particularly in the face of claim denials. 

If you're dealing with a workers' compensation denial in Springfield or any of the surrounding areas of Missouri, it's important to act quickly, understand the appeals process, and consult with a skilled workers' compensation attorney like those at Aaron Sachs & Associates, P.C. With the right information and guidance, you can better manage the challenges of a compensation claim denial.

To speak with an attorney about your rights and options, contact us online or call (888) 287-1046. Consultations are FREE and confidential.