Facing an injury on the job can be daunting, especially when your workers’ compensation claim meets with a denial. Yet, if you find yourself navigating this predicament in Tennessee, don’t lose hope. A variety of actions exist that you can take to challenge the denial and receive the benefits you deserve.
It’s important to note that denial doesn’t mark the end of the journey. The process can have its complexities and may require tenacity. Below are some proactive steps you can consider if your workers’ compensation claim faces denial.
Understand the denial letter
Understanding the reason for claim denial forms the crux of the process. The denial letter should contain an explanation for the decision. Frequent reasons include not adhering to filing deadlines, lack of evidence to prove the injury as work-related or the employer disputing the claim. A meticulous review of the letter can provide a sound foundation for the next steps.
Appeal the decision
Tennessee law allows a worker, faced with a claim denial, to appeal to the Tennessee Bureau of Workers’ Compensation. You need to ensure that the appeal filing happens within one year from the date of injury or from the last voluntary payment made by the employer, whichever comes later.
Gather more evidence
To support your appeal, you may need to gather more evidence. This could encompass medical records, testimonies from witnesses or any other data that supports your claim. The more comprehensive your evidence, the better your chances to win the appeal.
Tennessee mandates mediation as part of the appeals process. You and the opposing party will meet with a mediator from the Bureau of Workers’ Compensation to try to reach an agreement. Remember to present all your evidence and state your position clearly during mediation.
Present your case before a judge
If mediation doesn’t bring forth an agreement, your case will proceed to a hearing before a judge. The judge will hear both sides and review all the evidence before making a decision.
Seek recourse with the Appeals Board or Supreme Court
If the judge’s decision doesn’t favor you, you still have the option to appeal to the Workers’ Compensation Appeals Board or, eventually, to the Tennessee Supreme Court.
The denial of a workers’ compensation claim in Tennessee is not the final word. Several steps exist for a worker to challenge the decision.