What Happens When Your Medical Claim Has Been Denied and You Have Been Terminated?

In a worst-case scenario, the employer is refusing to pay your medical claim and now has terminated you for “reckless behavior” on the job. While this rarely happens, remember that the employer must have irrefutable proof that your accident was a case of gross careless or reckless behavior. This would include testimony from other workers and copies of on-site videos showing you acting in an irresponsible manner.

Your First Steps After a Work-Place Injury

If you are injured on the job, file a claim at once, so if you are accepted, you can begin receiving your financial and medical assistance. You should follow all the rules that are required of you, including meeting with the insurer’s physician who needs to exam you for the claim. If you are getting resistance from your employer, and he or she decides to terminate you, then you need to begin pulling evidence together.

Once you can do so, while recovering from your injury, connect with your fellow employees for their side of the story and ask them to provide you with statements about the accident. Try to get copies of any CCTV videos in the area where you worked that proves you were not careless.

Depending on the character of the employer, you may have difficulties in getting the proof you need, especially if you have already been fired from the job under false pretenses. If you are fired from your job, it also means you (and your family) will not have recourse to COBRA insurance either, to take care of your medical bills.

When Your Medical Claim is Denied

If you receive a medical claim denial from the Industrial Commission of Arizona (ICA), then immediately file a Request for Hearing on your case within 30 days of receipt of your termination letter. Bring an attorney with whom you have already discussed the case with. You need someone to help you who knows how the legal system works, and who can show you how to present yourself and your case.

Pull together any statements you can get and write down your own statement of what happened at the time when you were injured, who said what, and how you were treated. This will be an in-depth statement that you would not have provided when you filed your worker’s compensation claim, and before you got fired.

If the judge at the hearing denies your case, and you and your worker’s compensation attorney decide you have enough evidence for a civil trial, then you will want to go ahead and file a Motion, Order, and Complaint about Worker’s Compensation and Wrongful Termination. The link shows a sample version of what would be filed. Your worker’s compensation attorney will have the necessary forms to file in this situation.

Your Hoped-For Outcome

If it is determined that your former employer lied about evidence given regarding your medical injury and workplace behavior, there could be severe penalties placed on your former employer, and the ICA may require the employer’s insurer to pay the medical and wages fees that you are due. This is preferable to a one-time settlement which will be all that you ever get, especially if you will have life-long medical bills from the workplace injury.

If you need help with your medical claim, call us at once. 602-346-9009