Appealing a Workers’ Compensation Claim in Mississippi
Workers’ compensation is a no-fault system, meaning those injured on the job have a right to file a claim and receive benefits without needing to prove fault. Unfortunately, there are situations in which your claim may get denied. While it could be the result of a simple mistake you made when reporting the incident and filing your claim, there are several other reasons that an employer or their insurance company may attempt to deny your claim or reduce your benefit amount.
Just as you have a right to file an initial workers’ comp claim, you also have a right to file an appeal if you don’t agree with the denial or believe that you did not receive fair compensation. However, filing an appeal can be a long and grueling process. Therefore, it is often best in these situations to work with an experienced workers’ compensation attorney to ensure everything is done correctly and to help relieve the stress and pressure of handling the case on your own.
The Mississippi workers’ compensation lawyers at Lunsford, Baskin, & Priebe, PLLC, help injured workers get the benefits they are entitled to after sustaining an injury on the job. Our lawyers represent ironworkers, construction workers, truck drivers, general laborers, firefighters, and first responders who have been injured on the job. Learn more about how to appeal a denial below, and contact Lunsford, Baskin, & Priebe, PLLC if you need assistance.
Who is Eligible for Workers’ Compensation in Mississippi?
Mississippi requires all employers with five or more employees to have workers’ compensation coverage. If they have fewer than five, they may still provide coverage should they choose to do so voluntarily, but it is not required. Unlike some states, Mississippi does not require a minimum salary for workers to be eligible for benefits.
If you receive a denial of workers’ compensation benefits, but the above eligibility requirements apply to you, you may need to file an appeal. There are various reasons why a claim can get denied, but if you believe the denial is unfair, you have a right to an appeal.
While most workers who are injured on the job are eligible for benefits, some types of workers are not included, such as:
- Independent contractors
- Farm laborers
- Non-profit employees
- Domestic laborers
- Employees of religious organizations
- Cultural organization employees
Reasons For Workers’ Compensation Denials
If your workers’ compensation benefits get denied, it does not necessarily mean that you are not eligible for benefits. Denials can happen for several reasons, including simple clerical mistakes. When filing a claim or an appeal, it’s important to understand the reasons a claim may get denied so you can avoid making any mistakes.
The following are the top most common reasons why claims get denied:
1. Injuries are not severe
For a worker to be eligible for benefits, their injury must meet certain thresholds. If your injury is minor and does not require you to seek medical care or miss days from work, then your claim can get denied.
2. Failure to report the accident in time
Mississippi law requires a workplace incident to be reported and a claim filed within 30 days. If you fail to report the accident to your employer or if your employer then fails to file a claim before the 30-day mark, your claim will likely be denied.
3. False statements
Lying about what happened can also result in a claim denial. If you or your employer make any false statements about the accident or your injury, it can lead to questions about the validity of your claim. If an insurance company or claim adjuster suspects the incident has been falsely reported or exaggerated, they might deny your claim.
4. Pre-existing conditions
In some cases, insurers will deny claims if they think the injury is the result of a pre-existing condition as opposed to a workplace accident. However, even if you have a pre-existing condition, you still have a right to claim benefits if your injury or illness did result from work performed on the job.
5. Delayed medical treatment
You should always seek medical attention for injuries sustained in the workplace. Without medical documents or doctor statements supporting your claim, it may get denied.
Employers or their insurance companies will sometimes deny claims if the worker was under the influence of alcohol or drugs when the incident occurred. While being intoxicated does not necessarily mean you don’t deserve benefits, it can make getting an approval more difficult.
How to Appeal a Workers’ Comp Claim in Mississippi
If your workers’ compensation claim gets denied, follow the steps below to file an appeal:
Step 1: Correct mistakes if necessary
Review your denial letter carefully. Though it is not common, denials can occur due to clerical errors. If you find that information such as a name, address, or date was incorrectly reported, you should contact the claims adjuster and have the issue fixed. If you still receive a denial, it is probably for another reason. Your next step will be to file an appeal.
Step 2: File an Appeal
You must start by filing a petition with the Mississippi Workers’ Compensation Commission. Be mindful that there are strict time limits for filing. You will have two years from the date of your injury to file. After your petition is received, the Commission will assign you to a workers’ compensation judge and inform your employer’s insurance company that you have filed a petition to dispute the denial.
If an agreement cannot be reached through an informal negotiation with the insurance company, a date will be set for an administrative hearing with a workers’ comp judge. Before the hearing, you will be asked to partake in what is called a “discovery” session, where you and the insurance company will be able to ask questions and exchange information to gather any evidence needed to support your case. This can be a long and complex process that can often take up to a few months to complete.
Once discovery is completed and the hearing date is set, you will be asked to submit a statement outlining your issues and any evidence collected to back up your dispute. After you have made your case in court, the judge will review the evidence and statements. Their decision will be mailed out following the hearing.
Step 3: Further Appeals
If the judge makes a decision that you do not agree with, you may then appeal to the Full Commission by filing a petition within 20 days of the workers’ comp judge’s order. You can request another hearing if you desire, but typically the Full Commission will make their decision without the need for another hearing. Once a decision is made, the Commission will mail their decision to you and the insurance company.
If you are still not happy with the decision, you may further appeal through the state court system and must do so within 30 days. All documents and records of your case will then be mailed to the Mississippi Supreme Court.
Keep in mind that, while you have every right to an appeal, the process can take a long time. It can be complicated to keep everything straight and know what steps you need to take and what paperwork you need to file during this time. For this reason, you must seek out an experienced attorney to handle the legalities of your claim appeal. Working with an experienced attorney ensures that you are organized and prepared to answer any questions put forth in a manner that will win you your deserved benefits.
Contact An Experienced Mississippi Workers’ Compensation Attorney
The process of filing for workers’ compensation can be tricky, and it’s easy for mistakes to be made. Additionally, appeals can be even more of a challenge and can extend the process even further. Our dedicated lawyers can help you at every stage of the workers’ compensation process to ensure the best possible outcome to get the compensation benefits you deserve.
For help with a Mississippi workers’ compensation claim, contact the workers’ compensation lawyers at Lunsford, Baskin, & Priebe, PLLC, for a free consultation.