What Happens After You Lose a Workers' Comp Case?


Suffering an injury while working can be very hard to overcome. A person endures the pain of the injury and the difficulty in filing a workers' compensation claim. Sometimes the claim will be denied due to technicalities or lack of medical evidence. If an individual loses a workers' compensation claim, there are other ways to obtain medical treatment and replacement wages, including private health insurance and Social Security disability.

File Appeal

The first option to consider after losing a workers' compensation case is whether to appeal the decision. An appeal would allow your case to be heard by a different judge, who may view the facts in your favor. It is important to consider that appeals are often lengthy and costly. They also can consume a great deal of time. But, if an injured worker wins, he may be entitled to attorneys' fees, costs, and back benefits.

Private Health Insurance

Payment of outstanding medical bills is an important consideration after losing a workers' compensation case. Private health insurance does not pay for treatment related to a workers' compensation claim. However, once an individual loses a workers' compensation case, he can resubmit all bills to his private insurance for payment. The insurance provider may request a copy of the order denying the claim. The downside to payment by private insurance is that the individual will still have to pay all copays out of pocket.

Social Security Disability

If an individual has a long-term medical condition, he can apply for Social Security disability benefits. This condition does not have to be work-related. The federal government follows a strict definition of disability. The medical condition must be disabling for at least a year or is expected to result in death. In order to receive benefits, an individual must meet a recent work test based on his age at the time of his injury and a duration of work test to show that he worked long enough under Social Security.

Return to Work

Most individuals simply return to work after losing a workers' compensation claim. Filing a workers' compensation claim does not mean that you lose your job. Many states have enacted legislation to prohibit this kind of discrimination. If an employee needs to take time off work to recover from the injury, he can use sick leave, vacation leave, paid time off or unpaid time off. Any medical bills can be submitted through regular health insurance.

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