As a Mississippi worker you are likely entitled to workers’ compensation benefits should you be injured in a workplace accident or suffer a job-related illness. The workers’ compensation system is a no-fault system that provides both medical treatment and wage replacement benefits to eligible workers who suffer a job-related injury or illness. In theory, it should be fairly simple for a worker to get approved for workers’ compensation benefits. However, in practice the road to approval of workers’ compensation benefits is often paved with obstacles and roadblocks.
If you have applied for Mississippi workers’ compensation benefits and received a Notice of Controversion indicating that your claim was denied, don’t give up. An initial denial does not mean your claim for benefits will never be approved. Instead, it means that you just encountered one of those roadblocks that many applicants do.
Because each workers’ compensation claim includes a unique set of facts and circumstances it is in your best interest to consult with an experienced Mississippi workers’ compensation attorney as soon as you are made aware that your claim was denied. In addition, the answers to the following five questions will be important as you move forward:
1. What reason was given for the denial? Your employer is required to provide you with a Notice of Controversion if the employer denies your claim. On the notice, the employer must explain the grounds on which the claim was denied. Common reasons why a claim is denied include:
a. The employer claims you are not a covered employee
b. The employee claims the injury or illness is not work related
c. The employer claims the injury or illness was pre-existing
d. The employer claims the employee was intoxicated
e. The employer claims the injury was intentionally self-inflicted
f. Technical grounds—your application was incomplete or did not provide enough information on which to base a decision.
2. Are you a covered worker? Most workers are covered under the Mississippi Workers’ Compensation Law. However, there are some exceptions to this general rule. Even if your employer is an exception to the rule, the employer may voluntarily provide workers’ compensation coverage though. Common exceptions include:
a. If your employer regularly employs less than five employees
b. You are a domestic or farm labor worker
c. Your work for a non-profit fraternal, charitable, religious or cultural organization
d. You are covered under a federal workers’ compensation system
e. You are an independent contractor. Note, however, that even independent contractors may be covered if they were working for an uninsured sub-contractor.
3. Is your injury or illness covered? In Mississippi, any injury that “arises out of the course and scope of employment” should be covered by workers’ compensation as are occupational illnesses and diseases if they are work related.
4. Did the employer deny the claim in bad faith? In Mississippi, if an employer’s denial of a claim, or any part of a claim, is not founded in the law, the employer can be sued by the employee for both actual and punitive damages. An experienced Mississippi workers’ compensation attorney should review your claim and provide you with an opinion as to whether or not the denial was made in bad faith. If you are a covered employee and your injury or illness is covered you could have the basis for a bad faith lawsuit.
5. What is the next step? If you still believe that you have a valid Mississippi workers’ compensation claim, you have the right to appeal the denial by filing Form B-5,11 “Petition to Controvert” with the Mississippi Worker’ Compensation Commission.
While it is certainly possible to get your Mississippi workers’ compensation claim approved after an initial denial, achieving an approval gets harder with each step in the appeals process. For this reason, it is very important that you consult with an experienced Mississippi workers’ compensation attorney as soon as you receive a Notice of Controversion.
no responses Comments