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If you’ve been injured on the job, you may be entitled to worker’s compensation benefits in New Mexico. However, there’s no guarantee that your claim will be accepted without complications. In fact, many workers face the frustration of having their worker’s compensation claim denied. If this happens to you, it’s important to know the steps you can take to challenge the decision and secure the benefits you deserve.
As workers compensation lawyers, we’ll guide you through what to do if your worker’s compensation claim is denied in Albuquerque and offer actionable steps to take in the event of a denial.
Understand the Reason for Denial
The first step when your worker’s compensation claim is denied is to understand why it was rejected. Insurance companies and employers are required to provide a written explanation outlining the reasons for denial. Common reasons for a claim being denied include:
- Lack of sufficient medical evidence
- Injury not related to work duties
- Missed filing deadlines
- Failure to report the injury on time
- Pre-existing conditions not properly documented
- Discrepancies in the injury details or timeline
Once you understand the reason for denial, you can determine the best course of action to address the issue.
Review Your Medical Records and Documentation
Worker’s compensation claims rely heavily on medical evidence to support the severity of your injury and its relation to your work activities. If your claim was denied due to insufficient medical records, you should contact your healthcare provider to ensure that your records accurately reflect the nature of your injury and treatment.
Consider the following actions:
- Request a detailed report from your doctor or specialist that outlines the connection between your injury and your work activities.
- If necessary, get a second opinion from another doctor to strengthen your case.
- Ensure that all medical bills, prescriptions, and treatment plans are clearly documented and submitted.
The more detailed and organized your medical evidence is, the stronger your appeal will be.
Appeal the Denial
In New Mexico, you have the right to appeal a denied worker’s compensation claim. You must file an appeal within a certain timeframe (usually within 30 days) from the date of the denial. The appeal process involves a hearing before a worker’s compensation judge, where you will have the opportunity to present evidence and argue your case.
The appeal process can be complex and time-consuming, but having an experienced lawyer on your side will ensure that you meet all deadlines, properly file necessary documentation, and present a compelling case.
Consult an Experienced Worker’s Compensation Lawyer
Navigating the complexities of a worker’s compensation claim can be overwhelming, especially if it’s denied. A knowledgeable worker’s compensation lawyer in Albuquerque will know how to handle the appeal process and can advocate on your behalf to get your claim approved.
A lawyer can:
- Review the details of your claim denial
- Help gather additional evidence to support your case
- Advise you on the next steps and potential strategies for the appeal
- Represent you during the hearing before the worker’s compensation judge
- Ensure that your rights are protected throughout the entire process
Legal representation can significantly increase the chances of your claim being approved during the appeal.
Request a Hearing Before a Workers’ Compensation Judge
If your claim continues to be denied despite your best efforts, you have the option to request a formal hearing before a worker’s compensation judge. This hearing is where both sides – you and your employer or insurance company – will present evidence and arguments.
At the hearing, you will have the chance to explain why your injury should be covered under worker’s compensation. The judge will review all submitted documents, medical evidence, and testimony, then issue a ruling. If the judge rules in your favor, your benefits may be reinstated or awarded.
6. Take Steps to Protect Your Rights
While you navigate the appeals process, make sure to take steps that protect your rights and avoid jeopardizing your claim:
- Continue to follow all prescribed medical treatments and document any new medical developments.
- Keep copies of all correspondence with your employer or the insurance company.
- Avoid returning to work before you are medically cleared unless it’s part of a rehabilitation program approved by your doctor.
- Do not accept a settlement offer from the insurance company without consulting a lawyer. Many initial offers are far less than you are entitled to.
Know Your Rights and Keep Records
Throughout the process, it’s essential to keep thorough records. This includes:
- Correspondence with your employer, insurer, and medical providers
- Work-related accident reports
- Any forms or documentation related to your claim or appeal
- Notes on any meetings or discussions regarding your claim
These records will help build your case, and having them readily available can save you valuable time should your case require further action.
If the Appeal Fails, Consider Further Legal Action
If your appeal is unsuccessful, you still have options. In some cases, it may be possible to pursue a civil lawsuit against your employer or third-party parties responsible for the injury (for example, in cases where negligence was involved). An experienced lawyer will be able to explain the available options and recommend the best course of action.
Conclusion
If your worker’s compensation claim is denied in Albuquerque, don’t give up. The process may feel frustrating and overwhelming, but with the right knowledge and legal guidance, you can increase your chances of having your claim approved. Understanding the reasons for the denial, gathering additional evidence, and appealing the decision are crucial steps toward receiving the compensation you deserve for your work-related injury.
If you need help navigating the worker’s compensation claims process or appealing a denial, contact us at Amador Law Firm. Our experienced team is ready to guide you through every step, ensuring your rights are protected and you get the compensation you need to recover and move forward. We have hundreds of 5-star reviews for a reason!