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Denied Claim — Resolving Disputes

My Adjuster Denied My Claim. Can I Appeal?
By law, your employer’s insurance carrier must notify you in writing if your adjuster denied your claim. This must happen within 21 days of them being notified of the injury. If you have been denied, or your insurer has failed to notify you of their decision within the 21 days, you have a right to apply for a hearing. If you have been denied, or ignored, please contact us today for a free consultation to see if an experienced attorney can help you.
Do I Need an Attorney for my Workers’ Comp Case?
The workers compensation system is set up so that you do not need an attorney in order to file your claim. The problem is, the system is confusing and cumbersome, leading to employees consistently being underpaid, being denied reasonable treatment, and being taken advantage of due to them not having an attorney. Statistics show that workers comp claims are being denied more and more (denials up 20% during 2013 to 2018, Lockton Analytics). However, even with this rise in denials, it is important to note that 67% of denied claims convert to paid claims within 12 months. Coincidentally, approximately 70% of denied claimants retain legal counsel. Seeing that the percentage of denied claims that retain legal counsel is nearly the same number of denied claims that convert to paid claims, it seems a shame that the remaining 30% of denied claimants do not retain an attorney. The consultation with an attorney is free. Call today to see if your claim can be converted to a paid claim.
Do I Have to Go to Court for Workers’ Comp?
No, you do not have to go to court for workers’ comp claims in most cases. The majority of cases are settled prior to going to the hearing (court). A typical case will proceed for 6-8 months before being scheduled to go in front of the Administrative Law Judge (ALJ) and during that time, there are several opportunities to strengthen your case in order to either get a settlement or have your claim convert to an accepted claim. See this chart of the timeline for a typical case. If your case does proceed to the court date with no settlement, you will appear before the ALJ with your attorney who will walk you through the entire process. While many will demand to “have their day in court,” most times it is wise to pursue remedies sooner so that you can get the medical treatment you need and get your life back sooner.
My Employer Is Saying That I Ignored the Safety Rules and They Are Denying My Claim. Is That Right?
No, they should not be denying your claim. While employers are entitled to enforce their safety rules, just as they are entitled to enforce other work rules, they cannot deny your claim outright for violation of the rules – even if you knowingly violated them. The workers’ compensation system can reduce an injured worker’s disability compensation by 15% if the injury resulted from the injured worker’s willful failure to obey an employer’s safety rules. But the medical treatment will still be covered. By the same token, an injured worker’s disability compensation may be increased by 15% if the injury results from the employer’s willful failure to follow safety standards.
Can I Sue My Employer?
Normally, no, you cannot sue your employer for a workplace injury. Utah Law establishes the Workers’ Compensation Act as the “exclusive remedy” for workplace injuries (34A-2-105). This is the design of workers comp—it limits the liability and lowers the cost (for the employer)—while at the same time making it ‘easier’ for the injured worker to receive benefits. There are two ways that you can sue your employer for an injury that happened while you were at work: 1) If the employer failed to carry workers’ compensation insurance, and 2) If the injury was due to the “willful and intentional” act of the employer or a fellow employee. Under the first scenario, where the employer does not have workers comp insurance, you have two options: 1) you can sue the employer as if there were no workers comp system; or 2) you can file a workers comp claim at the Utah Labor Commission and you will be covered under the workers comp system by the State. Do not let your employer “take care of it” if they do not have insurance—contact an attorney immediately. The second scenario is a bit tougher. You must prove that the employer willfully and intentionally allowed you to be put into a situation that they knew or should have known would likely injure you. This doesn’t mean you can sue because they knew the floor was wet. It is more likely reserved for the very select case where the employer was certain you would be harmed. In Helf v. Chevron, the Utah Supreme Court said that the injured worker cannot receive the benefit of both suing the employer and filing a workers’ comp claim. In Helf, the worker was sent into an area where another worker had been injured before and they had not changed anything to make it safe. This is the sort of circumstance where you may have a case to sue the employer. It is best to consult with an attorney to see if you are able to prove the necessary facts for this type of case.
Can I Sue My Co-worker?
Normally, no, you cannot sue your co-worker for a workplace injury. Utah Law establishes the Workers’ Compensation Act as the “exclusive remedy” for workplace injuries (34A-2-105). This is the design of workers’ comp—it limits the liability and lowers the cost (for the employer)—while at the same time making it ‘easier’ for the injured worker to receive benefits. This exclusive remedy also applies to any “officer, agent, or employee of the employer.” The only exception to this is for the premeditated and intentional act of a fellow employee. See Bryan v. Utah Int’l (1975). If you feel you have a claim for an act of a fellow employee for your work injury, it is best to consult with an attorney to see if there are sufficient provable facts for such a claim. If not, you will still be able to avail yourself of the workers compensation benefits.
Can My Employer Retaliate if I File a Workers’ Compensation Claim?
No, your employer is prohibited from retaliation for filing a workers’ compensation claim. “An employer may not suspend, discharge, discipline, threaten to discharge or discipline, or otherwise retaliate against an employee solely because the employee: (a) claims or attempts to claim workers’ compensation benefits.” Utah Code 34A-2-114. If you feel that you have been retaliated against, please contact an attorney to see the best options forward.

Client Reviews

My adjuster had denied my workers’ compensation claim for my on the job injury. I was not able to return to work and didn’t know where to turn. I was recommended to Tim Rose at Rose Legal and he took care of my...

Sarah P.

I had talked with several other attorneys before I found Tim Rose. Tim was able to explain the law to me in a way that the other attorneys failed. I now understood what needed to be done to help move my claim...

Miguel M.

We can't thank you enough for all you have done for us on our workers’ compensation claim. We'll never forget your kindness and dedication. It was such a positive experience for us. You were absolutely great!!!

Jill R.

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