Murfreesboro Workers’ Compensation Appeals Lawyer Fighting Denied Claims
When a worker receives a denial letter from an insurance adjuster, confusion follows. If you are facing denied workers’ compensation benefits, you need a workers’ comp appeals lawyer to review the decision and next steps.
R. Steven Waldron, Attorney at Law, based in Murfreesboro, Tennessee, is led by attorney Steve Waldron. He offers more than 50 years of experience fighting for Tennessee workers. He has been consistently selected to the Super Lawyers list each year since 2006 and works on a contingency-fee basis, meaning you pay no attorney fees unless the firm successfully recovers benefits for you. Contact Steve Waldron, Attorney at Law in Murfreesboro for a free consultation to discuss your appeal.
Why Was Your Tennessee Workers’ Comp Claim Denied?
Insurance carriers and the Tennessee Bureau of Workers’ Compensation deny claims for various technical reasons. Common grounds for denial include:
- Missed reporting deadlines: Failing to provide notice of injury within the strict 15-day notice period.
- Disputed cause: Arguments that the injury is not work-related or arose from outside activities.
- Preexisting conditions: Claims that the injury is a degeneration of a prior issue rather than a new workplace event.
Do not panic if you have received a denial. A denial letter is often just the beginning of the negotiation process, not the final word. However, you should review the specific explanation for the denial and consult with an experienced attorney before responding to the insurance adjuster yourself.
Steps To Overturn A Denied Claim
Overturning a denial begins with filing a Petition for Benefit Determination (PBD). This is a formal step that challenges the insurer’s decision and alerts the Bureau of your intent to contest the claim.
The process typically involves:
- Mediation: You will likely attend a Benefit Review Conference (BRC). Tennessee mediators are neutral facilitators who help resolve disputes without the need for a formal trial.
- Evidence preparation: To succeed, you must build a strong case supported by medical records, employment details and witness statements.
- Legal representation: A workers’ comp appeals lawyer is critical at this stage to ensure proper filing and to present your medical and employment history in the light most favorable to your claim.
Navigating “Utilization Review” Denials For Medical Treatment
Sometimes a claim is accepted, but the insurance company refuses to pay for specific procedures, such as MRIs, surgeries or physical therapy, because of the “utilization review.” This is when the insurer’s own doctors challenge the medical necessity of your treatment.
If you have been hit with a UR denial, you do not have to accept it. In Tennessee, injured workers can file a Form C-35A to formally challenge these decisions. Because these medical denials can halt your recovery and cause unnecessary pain, prompt legal intervention is essential to get your treatment back on track.
Can You Sue Your Employer If Your Claim Is Denied?
A common question is whether you can sue your employer directly for a denied claim. In Tennessee, workers’ compensation is generally your exclusive remedy, meaning the system acts as an administrative process rather than a civil lawsuit. In most cases, you cannot sue your employer for a standard denial.
However, there are limited exceptions where civil lawsuit may be an option, such as:
- Intentional harm: If the employer acted with clear intent to cause injury.
- Third-party liability: If your injury was caused by a party other than your employer (such as a defective machine or a negligent vendor).
- Failure to carry insurance: If the employer was required to carry workers’ compensation coverage but failed to do so.
If your situation does not fall into these narrow exceptions, your path to recovery is through the Tennessee workers’ compensation appeals process.
Schedule A Case Review Today
If you received a denial letter from a Tennessee insurance adjuster, take action today by contacting R. Steven Waldron, Attorney at Law, to speak with a workers’ comp appeals lawyer. Call 615-890-7365 or send an email via the contact form to schedule a free consultation.