It's Difficult To Know What To Do When Your Claim Is Denied
At Donahoe Kearney we go to bat for our workers' comp clients: which means if they are not getting the treatment and/or benefits they deserve, we will file for a formal hearing on their behalf. But what if your claim was just denied and you're not sure what to do? Maybe the insurance adjuster is encouraging you to file for an informal conference to resolve your differences. But what they are not telling you is that informal conferences rarely do anything to help an injured worker. They are just another delay tactic for the insurance company.
When we have clients whose claims are contested, we go straight to a formal hearing.
The difference between an informal conference and a formal hearing is pretty simple: for an informal conference we are just meeting with a claims examiner who will help us to resolve our conflict with the other side. The claims examiner will issue a recommendation that is nonbinding, but may become final if both sides agree. This is unlikely, because the insurance company can reject the recommendation of the claims examiner for any reason and request a formal hearing instead.
There Are Very Few Situations We Request Informal Conferences For - And Never If Our Client Is Not Getting Paid
A formal hearing is a condensed, on the record trial where you file exhibits, call witnesses and make opening statements and closing arguments. The decision from the formal hearing is binding, but can be appealed. If handling a case yourself, you'll also have to understand all the ins and the outs of the process (discovery, medical records, exhibits, procedure) but we take care of all of the legal issues for our injured worker clients and we DO communicate with our clients on what to expect. Here's an example of a letter that we send to our clients when we have filed for formal hearing:
I just wanted to let you know we requested a Formal Hearing in your case to get you the workers' comp benefits the insurance company has denied (or delayed). We take this seriously and are aggressive about this approach - if the insurance company isn't doing what we think they should for you, we take them to court.
There is nothing you need to do right now, but here's what you can expect:
- You will receive a Scheduling Order in a few weeks with the date of the Formal Hearing and a lot of other dates leading up to it. Put the Formal Hearing date on your calendar and plan to be there, but don't worry about the other dates in the Scheduling Order - we take care of all of that.
- We get the Scheduling Order as well, and we'll call or email you to make sure you got it.
- We will thoroughly prepare you for the hearing and contact you to schedule meetings with Mr. Kearney as we get closer to the hearing date.
- Unfortunately, there is nothing we can do to move up the hearing date - these are being set about 4 months from the time we request the hearing. Sometimes these are re-scheduled because of conflicts with the lawyers' schedules, the judge, etc., but only by a week or so.
- We keep talking to the insurance company lawyers, to try to get them to provide the benefits before we ever have to go to the hearing, so rest assured we are doing everything we can to speed up the process.
- We'll be working on your case a lot between now and the hearing - be sure to keep us updated on your condition and medical treatment, like always, becasue we will probably need more frequent updates.
And if anything changes, we will let you know as soon as we hear. Finally, hang in there - we know it is a difficult and unfair system that favors insurance companies. But we will do everything we can for you.
If Your Claim is Being Denied, You Need an Experienced Workers Compensation Attorney to Help. Call Ours Today!
Have you been given the run-around by the insurance company? Have they stopped, or delayed paying your workers comp benefits or medical treatment? You may need to file a formal hearing and for most people we don't recommend doing this one your own (some can, if the case is small and/or straightforward). Give us a call today at 202-393-3320 to see if we might be the right firm for you. The call is free and confidential, so you have nothing to lose. Give us a call today to speak to a real person who wants to hear your story.