Worker’s Compensation and Denial of Death Benefits

When insurance companies hit you when you're down

No one likes to talk about death. We use colloquial terms for it, hide it behind curtains, use hushed tones and whispers and talk behind our hands so the children can't hear. It has to be hidden at all costs.

That's why when we have to deal with it, nobody knows what to do. We wander around like stunned zombies, wide-eyed and silent, moving from one place to the next, waiting for instructions. We hope someone else will come in and take over, someone more adult than us. But now we're the adults, and we need to make the decisions.

When a loved one passes away, taking care of his affairs is one of the hardest things to do.

When someone dies because of a job he was doing, that is even harder.

When someone dies and the insurance company starts jerking you around, well… that's just adding insult to injury.

When the insurance company denies death benefits

Let's say a loved one passed away while working a construction job. It is the worst possible scenario in terms of worker's compensation, and it means that you, the family member, have to step in and assume control of the situation. This means filing the necessary paperwork with the insurance company that shows your family member suffered an injury on the job that ended his life and also providing the evidence that supports the claim.

Insurance companies, however, are in the business of making money. They aren't going to hold your hand and tell you how very sorry they are. Appallingly, sometimes they will send a form letter with a stamped signature denying your claim for a variety of reasons. Let's review what those reasons are.

• The claim was not reported or filed on time: You don't want to let this happen. While it might seem crass, you want to report the accident to the employer within days of its occurrence. That way it is properly documented for insurance purposes. You must report the injury in writing within a certain number of days, usually 30 – though it might vary by state. Checking with a worker's compensation attorney in your specific jurisdiction would be advisable. In Colorado, claims are supposed to be reported in writing by injured workers or their dependents within four days of the date of the injury.
• The employer disputes the claim: Hopefully your loved one's employer wouldn't be completely insensitive about the situation, but he might see an opportunity to protect his liability. If that is the case, then you will have to prepare for a fight. This means providing additional information about the accident so the insurance company can see more of the picture.
• It was a pre-existing condition: This ties into the previous point, but the employer might try to argue (or the insurance company might try to argue) that your loved one suffered from a pre-existing condition that contributed to his death. For instance, if he passed away from a form of cancer, the insurance company will say that it is impossible to state for certain whether the materials he was working with for 25 years contributed to his asbestosis and that his cancer developed for another reason, not because of his asbestos-riddled working conditions.
• Nobody saw the accident occur: This is usually the biggest problem. If nobody was around when someone fell off a ladder or was in an accident while transporting materials, then there is no independent witness to testify, and then really, anything could have happened. As such, the insurance company is free to deny, deny, deny – even though there is clearly a person who is no longer on this mortal coil.
• The insurance company disputes your or your children's relationship to your deceased spouse.  As shocking as it may sound, insurance companies often deny claims for death benefits questioning whether a surviving spouse was actually married to the deceased or whether the deceased's children were actually his or hers.  The surviving dependents then are forced to prove that they are in fact the surviving spouse and children.

What can I do to appeal the insurance company's denial?

Insurance companies are just that – companies. However, when you get a person on the phone, you can find a spark of humanity within them. Grab on to that and don't let go. Find the sympathy in their hearts and remind them that there is a person who is not here anymore.

What you need to do is build as much of a case as you can. Even in your state of grief, this is an unfortunate necessity. Gathering additional information, such as witnesses, photographs, statements and testimony can help bolster your claim so that when you submit your claim again, the insurance company has to give you a second chance.

If all else fails, an experienced worker's compensation attorney is your best bet. This is a nuanced area of law, and most attorneys have someone to whom they refer these cases because they refuse to deal with them. They are too complicated and too involved for a general lawyer to handle.