If you’re injured on the job, you’re entitled to workers’ compensation benefits in Nebraska. But what are your options if your employer’s insurance company denies your claim or doesn’t provide the benefits you expected? This article explains some of the common reasons insurers reject claims, and how to appeal with the Nebraska Workers’ Compensation Court (WCC).

Common Reasons for Denying Workers’ Comp Claims

You may lose your right to benefits if you don’t promptly notify your employer about your injury or occupational disease. New Mexico law requires that you turn in a written, signed notice as soon as it’s feasible. Your employer or its insurance company should then file a report with the WCC, but you won’t be responsible for any delays.

The insurance company may deny your claim if it decides that your injury or illness doesn’t meet the legal requirement for workers’ comp coverage: “arising out of and in the course of employment.” This means you were hurt while you were working, and job conditions or activities caused your injury or illness. For example, you probably can’t get workers’ comp if:

• you were hurt on your way to or from work or a work-sponsored social event
• your injuries resulted from natural causes like a tornado, or
• your injury or illness resulted from the natural progression of a preexisting condition.

Nebraska law specifically bars workers’ comp coverage in certain situations, such as when:

• the injury resulted from your deliberate actions, reckless indifference to safety, or intoxication
• you refused a request from your employer or its insurance company to undergo a medical examination, or
• you were hurt because you had lied about your physical or mental ability to do the job before you were hired.

Learn more about other common reasons for denied workers’ comp claims.

How to Challenge a Denied Workers’ Comp Claim

You have the right to appeal if the insurance company denies your claim. The first step is filing a petition with the WCC within two years after you were injured or learned about your occupational disease. If the insurance company started paying benefits but then stopped, the two-year time period starts with the last payment.

Informal Dispute Resolution

Before a formal hearing, you and the insurance company may ask for an informal dispute resolution process with a WCC staff member or an outside mediator. A WCC judge may also send the case to mediation.

Compensation Court Hearing

If both sides can’t reach an agreement during mediation, your case will proceed to a formal hearing with a workers’ comp judge. At the hearing, the judge will hear testimony from witnesses and consider other evidence. You should get a decision within 30 days after the hearing.

Taking Your Case to Appellate Courts

If you aren’t happy with the WCC judge’s decision, you can file another appeal within 30 days, this time with the Nebraska Court of Appeals. After that, your last option would be to seek an appeal before the Nebraska Supreme Court.

Reach Out to a Lawyer

The workers’ comp appeals process can be complicated and requires detailed knowledge of Nebraska workers’ comp law, the Nebraska Workers’ Compensation Court, and the Nebraska court system in general. An experienced workers’ comp attorney can explain the legal procedures and how the rules apply to your situation, help you gather evidence to support your claim, represent you at hearings, and protect your rights throughout the appeals process. Learn more about what a good workers’ comp lawyer should do and how much workers’ comp attorneys cost in Nebraska.

Share on Google Plus

Share on Facebook