Getting hurt at work is stressful enough without having your workers’ compensation claim denied. You might feel overwhelmed and unsure about your next steps. The good news is that a denied claim doesn’t mean the end of your case.
You have several options to fight back when your claim gets rejected. Iowa law provides multiple ways to challenge a denial and seek the benefits you deserve for your workplace injury.
How Iowa handles workers’ compensation claims
Iowa requires most employers to carry workers’ compensation insurance to protect their employees. When you get injured on the job, your company’s insurer reviews your claim to determine if you qualify for benefits. The insurance company looks at medical records, accident reports and witness statements to make its decision.
Your employer must report your injury to the Workers’ Compensation Commissioner within four days of learning about it. The insurance company then has time to investigate before approving or denying your claim. During this process, your employer gets to choose your medical provider, though you can request alternate care if needed.
Benefits available to Iowa workers
Workers’ compensation provides several types of substantial benefits to help you recover from your workplace injury. These benefits can make a significant difference in your financial stability while you heal. Potential benefits include:
- Medical care coverage for all reasonable and necessary treatment
- Temporary total disability payments when you cannot work at all
- Temporary partial disability benefits when you can only work limited hours
- Healing period benefits while recovering from permanent impairments
- Permanent total disability compensation for those unable to return to work
- Death benefits for families of workers who die from job-related injuries
On average, workers’ comp covers two-thirds of an injured employee’s lost wages. These benefits help cover your medical bills and replace a portion of your income during your recovery. The specific amount and duration of benefits depend on your injury severity and how it affects your ability to work.
Reasons for denied Iowa workers’ comp claims
Insurance companies deny workers’ compensation claims for many reasons. Some common causes include disputes about whether your injury happened at work or resulted from your job duties. The insurance company might argue that you had a pre-existing condition that caused your problems instead of a workplace accident.
Other denials occur when you miss important deadlines, such as failing to report your injury within 90 days. Sometimes insurance companies claim you weren’t actually an employee or that your injury wasn’t severe enough to warrant benefits. They might also deny claims if they believe you were intoxicated or violated safety rules when the injury occurred.
Understanding the specific reason for your denial is crucial before filing an appeal. An experienced workers’ compensation attorney can review your case and help you determine the best strategy to challenge the insurance company’s decision.
Deadlines to file a workers’ comp appeal
Time limits are crucial in workers’ compensation cases, so you must act quickly after a denial. You have two years from the date of your injury to apply to arbitration if you haven’t received any benefits. If you’ve already received some benefits, you have three years to request additional compensation.
Missing these deadlines can permanently bar you from receiving benefits. Mark these dates on your calendar, contact a lawyer if you don’t already have one and don’t wait until the last minute to take action. The sooner you start your appeal, the better your chances of success.
How the appeals process works in Iowa
You have several options when your workers’ compensation claim gets denied. The appeal process gives you multiple chances to present your case and fight for your benefits. Your options include:
- Requesting a detailed explanation from your employer and insurance company
- Contacting a Workers’ Compensation Compliance Administrator for help
- Filing a contested case proceeding before the Iowa Workers’ Compensation Commissioner
- Presenting evidence and testimony to support your claim
The contested case proceeding works like a court hearing where you can present medical evidence, witness testimony and other proof that your injury is work-related. The Commissioner reviews all evidence and makes a binding decision about your benefits.
A skilled workers’ compensation attorney can guide you through this complex process from the beginning, as well as help you build the strongest possible case for your appeal.