Appealing an Alabama Workers’ Compensation Denial

Injured workers expect their employer to be there for them after an accident. Unfortunately, many employers and insurance companies search for every possible loophole to deny injured workers’ rightful claims to workers’ compensation benefits. If you received a denial from your employer’s insurance company for workers’ compensation benefits, you could fight it by appealing the denial of your claim. While that might sound burdensome, you don’t have to do it alone. The workers’ compensation team at Gartlan Injury Law is dedicated to helping injured workers seek the benefits they need and deserve after a workplace accident.

What Is Workers’ Compensation?

Workers’ compensation is a form of insurance that most employers must carry to protect their employees when they get injured on the job. Workers’ compensation benefits can be claimed by employees when they suffer injuries in the workplace, regardless of who is at fault. This is important, considering the high number of workplace accidents that lead to injuries every year in Alabama and across the country. For instance, Alabama private industry employers reported 85 fatal workplace injuries and 33,800 non-fatal workplace injuries and illnesses in one recent year, according to the U.S. Bureau for Labor Statistics.

Are All Employers in Alabama Required to Carry Workers’ Compensation Insurance?

In Alabama, employers with five or more employees must have workers’ compensation insurance. Employees can be either full-time or part-time, but independent contractors are not covered by this insurance.

Some employers are not required to carry workers’ compensation insurance. In other words, they are exempted from the requirement. Those employers include:

• Employers of domestic workers
• Farm-labor employer
• Employers with casual employees
• Municipalities with a population of 2,000 or less.

What Does Workers’ Compensation Cover in Alabama?

Alabama workers’ compensation covers the following expenses for injured workers:

• Reasonably necessary medical expenses — These benefits include medical, surgical, and chiropractic treatment, medications, medical and surgical supplies, crutches, prosthetics, and other medical equipment or devices required during the employee’s disability.
• Weekly compensation benefits — These benefits are calculated as two-thirds of the employee’s average weekly wage for the past 52 weeks. The benefits can last up to 300 weeks in the case of temporary or permanent partial disability or for an unlimited period in the case of temporary and permanent total disability. Injured workers with total or temporary partial disability are subject to a three-day waiting period. If the disability lasts 21 days or more, the employee will receive compensation for the first three days of disability.
• Burial expenses — If an injured employee dies after the accident, the decedent’s family can receive compensation for burial and funeral expenses up to a maximum of $6,500.

What Are Common Reasons Claims are Denied?

For many reasons, an injured worker’s claim for workers’ comp benefits may be denied. Those reasons include:

• The worker took too long to report the injury or file the claim.
• No one witnessed the accident.
• The worker allegedly lied about the injury.
• The injury is suspected of having occurred outside of work.
• The worker failed to follow their doctor’s orders.
• The worker had a preexisting condition that contributed to the injury.
• The worker’s willful misconduct allegedly caused the accident.
• The worker is accused of self-harm.
• A third-party or fellow employee caused the injury for non-work reasons.
• You are accused of being drunk at the time of the injury.
• You failed to use the safety gear provided by your employer.
• The injury resulted from the worker’s knowing, willful violation of the employer’s rules and regulations.

How Do I Appeal a Denied Claim in Alabama?

If your workers’ comp claim is denied in Alabama, no administrative court system will consider the appeal of your denied workers’ compensation. Instead, you must file a civil lawsuit in state court to contest a denial of workers’ compensation benefits. As with other lawsuits, it is imperative that you have an experienced workers’ compensation attorney to represent you.

Before filing a lawsuit, you can request assistance from the Alabama Department of Industrial Relations through its Ombudsman Program. However, the Ombudsman Program can resolve disputes over medical benefits. The program also offers mediation services for non-medical disputes, but you and the insurance company must agree to participate.

The Ombudsman will only facilitate mediation between the two parties and does not have the authority to make binding decisions. If it works, the mediation process could help you resolve your claim denial more quickly. Unfortunately, most insurance companies will not agree to mediation if they have already denied a worker’s claim.

So, typically, a worker must file a civil lawsuit in court in the district where they worked, or where the accident occurred. The lawsuit will go through the same process as other civil lawsuits.

• You must file a complaint in the proper district court.
• The insurance company must file an answer in court.
• You and the insurance company will gather evidence through the discovery process.
• A judge will hear your case. These are known as bench trials.
• The judge will enter a judgment.

An employer’s insurance company may try to reach a settlement agreement with the worker before trial to avoid the extra expense of a court hearing. If this occurs when you appeal your denied claim, an aggressive workers’ compensation attorney could negotiate for a fair settlement on your behalf. If the insurance company refuses to settle on reasonable grounds, a highly experienced workers’ comp attorney will be ready for trial.

Is There a Deadline to File a Workers’ Compensation Lawsuit?

Yes, a critical deadline, or statute of limitations, limits the time for filing a workers’ compensation lawsuit in Alabama. The filing period is two years from the date of the injury or two years from the date that the worker last received temporary total disability benefits, whichever date comes later.

Contact an Alabama Workers’ Compensation Attorney Today

If your claim for workers’ compensation benefits was denied, contact an experienced Alabama workers’ comp attorney immediately. You have a short period to pursue workers’ comp benefits, and the process will not be easy. The workers’ compensation lawyers at Gartlan Injury Law can help you step-by-step to appeal your denial and fight for the benefits you need and deserve. Contact Gartlan Injury Law today to discuss your case with a knowledgeable workers’ compensation attorney in a free consultation.

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