Imagine you are at work in Alaska and you get hurt. Maybe you lifted something too heavy or too many times, or you slipped on a wet floor in an area without a sign alerting you of a wet floor.
The accident resulted in an injury and you are ready to file a workers’ compensation claim, assuming no problems will arise with its approval.
Denials happen
Now, imagine you are at home and your employer’s insurance company sends you a letter saying that they have denied your claim.
You probably feel shocked—you never expected this to happen. After all, you got injured on the job. You say to yourself that this surely must be a mistake. Confused and upset, you wonder what to do next.
Your claim is denied. Now what?
Let’s say they deny your workers’ compensation claim and you are confident it must be a mistake. Unfortunately, it is not a simple, informal process to communicate that to the insurance company, and there is an established procedure that you must go through.
It is not as simple as picking up the phone, talking with someone, explaining why it’s a mistake, and them approving your claim.
In fact, if they deny your claim, they will explain to you why they denied it. For example, they can deny your claim because:
- The insurance company does not believe your injury qualifies for compensation
- The injury not being related to your job
- The insurance company does not have enough information about your injury
- You sent your claim in after the deadline, or the insurance company received it late
What you can do
The next step is to focus on the reasons for the denial. Of course, you can have an attorney help you with this. After all, workers’ compensation attorneys deal with denials every day and know what to do. If you can do this, it might give you the best shot at a successful outcome.
However, keep in mind that the process is the same. The most critical action here, however, is for you to:
- Gain an understanding of why they denied your claim
- Please read the letter carefully and understand what they are telling you
File an appeal
In Alaska, you can appeal their denial. The process involves the following steps:
- Request for reconsideration: this is your first appeal. You ask the insurance company to review your claim again. You must make this request within 60 days after you receive the letter they sent you denying your claim.
- Appeal to the Alaska Workers’ Compensation Board: if the insurance company still denies your claim, you can take your case to the Alaska Workers’ Compensation Board, where a panel will take the information from your side and the insurance company’s side and decide whether you qualify for workers’ compensation benefits.
If you appeal to the Alaska Workers’ Compensation Board, ensure you are prepared to present your case clearly. Have an attorney with you if you can. The Board will set a hearing, and you and the insurance company will present your side of the story.
Further appeals
Now, let’s say the Board denies your claim. If the Board denies your claim, is it all lost? Not necessarily. You can actually appeal to the Alaska Workers’ Compensation Appeals Commission. This Commission will review the Board’s decision to ensure they followed the law correctly.
If the Commission tells you that the Board was correct in its decision, you can take your case to the Alaska Supreme Court.
In summary, you will have three opportunities to appeal, and if none of those work, you can still take your case to the Supreme Court.
It is critical to understand that denials are telling you something. Ensure you have a robust case and gather as much evidence as possible, even if you are running in circles.
Get double the evidence, or triple it if possible, to show that your claim is valid and makes you eligible for workers’ compensation benefits.
