What Could Cause a Workers’ Compensation Claim to Be Denied?

There are many reasons this can happen. This is by no means a complete list, but it is meant to provide some insight into what causes denials.

  • Lack of or incomplete doctor’s records. Workers’ compensation claims usually need to be backed up by a physician who has examined the worker and made a complete diagnosis and a prognosis for if or when the victim may return to work.
  • The victim didn’t seek medical help. Workers’ compensation will want corroboration of the injury from a medical professional.
  • The injury was reported too late. In Mississippi, the victim must report the injury to the employer within 30 days of its occurrence.
  • Missed deadline. Workers’ compensation claims usually have deadlines. If the worker misses the deadline, the claim may be automatically denied.
  • The accident doesn’t appear to have happened while the victim was at work. Workers’ compensation may deny the claim if the injury doesn’t appear to have happened at work.
  • The employer disputes the claim. They may say it happened away from work or because of the victim’s reckless behavior. However, Mississippi’s workers’ compensation program is essentially a no-fault program, meaning it shouldn’t matter if the employee caused the injury. If it happened while on the job, it should be eligible for workers’ compensation.
  • The victim may not qualify for workers’ compensation under Mississippi law. There are several exceptions to Mississippi’s workers’ compensation laws, including employers with fewer than five employees, nonprofits, domestic or farm laborers, or independent contractors.

Is it Possible to Appeal a Denied Workers’ Compensation Claim in Mississippi?

As frustrating as it is to be injured in the workplace, it can be even more so to find that the workers’ compensation claim was denied. But the process doesn’t have to end there; if someone suffered a workplace injury, filed for workers’ compensation, and was denied, they have the right to file an appeal. Like other aspects of filing for workers’ compensation, there are requirements and deadlines that must be followed. That’s why it’s crucial to work with an experienced workers’ compensation attorney who understands the requirements and process.

There may be multiple steps to filing an appeal. The process begins with filing something called a petition to controvert with the Mississippi Workers’ Compensation Commission (MWCC). This
must be done within two years of the date the injury occurred. The commission then assigns a judge to your case. At this point, the case may go one of two ways: It’s possible that a negotiation will begin and may result in a settlement that both parties agree to. If not, it may lead to a hearing.

A hearing would take place in front of a judge, with both parties presenting their sides. Each party could present evidence and testimony, including testimony from expert witnesses. This
is not necessarily a speedy process; it’s not unusual for it to take months from when the petition is filed to when the hearing is concluded and the judge issues a decision. That’s one reason many people opt for negotiation instead because they’ll receive the financial compensation sooner than they would through a hearing. Another reason is that the hearing represents an unknown outcome, while the settlement is a known quantity.

Whether or not your case should be negotiated or go to a hearing depends on numerous factors and should be discussed with an experienced workers’ compensation attorney.

What if the Judge Rules Against Me After the Hearing?

You’re not out of options yet. Even if the judge rules against your petition, there’s the option to appeal the decision to the commission. It must be done quickly–this appeal has to be filed within 20 days of the judge handing down their decision. In this appeal, both sides provide written briefs that explain their position and why they believe the judge was correct or not. The full commission usually, but not always, decides without a hearing.

If the commission upholds the judge’s decision, there’s a final step that may be taken, and that’s taking the case to Mississippi courts. That must be started within 30 days of the commission’s ruling. How long it takes in court depends on various factors, including how many state court levels it may go to. In some cases, it could end up in the Mississippi Supreme Court. That may take several months or even years.

What if a Third Party Was Involved in the Injury?

It’s not uncommon for the injury to occur due to something beyond both the employer’s and the employee’s control. For example, say the employee was injured while using a piece of machinery that malfunctioned due to a defect the employee and employer were unaware of.

The employee can still file for workers’ compensation, but they may also be able to file a claim against the third party as well. Among the types of claims that can be made to the third
party are out-of-pocket medical costs (potentially including future costs), lost wages or future earnings when the injury is severe enough, and pain and suffering.

What Should I Do if My Workers’ Compensation Claim in Mississippi Was Denied?

Call the Rundlett Law Firm at 601-282-8426 for a free, in-depth, no-obligation case evaluation. We understand how frustrating and stressful this situation can be. Our team of experienced, knowledgeable workers’ compensation attorneys can help you determine why the claim was denied and what recourse you might have.