Why Your Defense Base Act Claim Was Denied And What You Can Do About It
As a contractor working overseas, you are exposed to many risks. Either working on military bases, in security positions or under public works contracts, the risk for injury or death is higher than many other occupations, particularly those in a war zone. Yet, day in and day out you head into work, confident that if you do get injured, you can file your Defense Base Act claim with your employer’s insurance carrier and you’ll receive the compensation you deserve. Still, you’re cautious in following closely every safety protocol.
Then it happens – you’re injured while on the job. As you lay in the hospital or medic’s office, you’re thinking through all the things you need to do to file a claim to replace the income you might lose because of the injury. You’ve reported your injury to your employer and started the paperwork. When you’re well enough, you send in your DBA claim, confident that your Defense Base Act insurance will approve it immediately.
When The Paychecks Stop Coming
You wait, at first patiently, but then the paychecks stop coming and the hospital bills start arriving; yet, there’s still no word about your claim. Finally, you receive a letter in the mail that makes your heart jump from your chest and into your throat: Your claim has been denied. As the panic subsides, anger may start to seep to the surface.
“Why was my claim denied?” you think to yourself. “I provided all the information to substantiate my claim. It seemed like such a clear-cut case!”
The reality is that although it might seem like a straightforward case to you, the insurance company might not like the amount they have to pay you or the fact they have to pay you anything at all. So, they look for any reason to deny your claim. There are a number of reasons why your claim can be denied, and it varies from case to case, but unfortunately, it often boils down to money. Insurance carriers do not want to pay out expensive benefits if they can avoid it because it comes at a great cost to them.
Although money is often what it comes down to, there are other reasons why a DBA Insurance company might deny or contest your claim.
1. It’s Unclear It’s A Workplace Injury
If you’ve ever read your employment contract carefully, you know all the responsibilities you have to uphold for the duration of that contract. If you’re injured during any of those duties, then you are covered under the Defense Base Act. However, sometimes responsibilities and obligations extend past your place of work and even direct work duties. At this point, it might not be clear whether your injury took place within the course and scope of your employment.
For example, let’s say that you were injured while fishing off-duty. It seems that this would not be covered. However, you work on a remote island that requires you to provide for yourself for some of the meals during the week, as per your contract. The primary way to do that is through fishing. Your DBA lawyer should be able to make the case that your injury was within court and scope of your employment, also referred to as the “Zone of Special Danger”. There are many cases that talk about what constitutes an “injury” within the Zone of Special Danger and an experienced DBA lawyer can help explain the law to you and advocate on your behalf that your injury is covered by the DBA even if not directly related to your work duties.
2. Your Injury Wasn’t Serious Enough Or Didn’t Require Medical Attention
If your claim is denied because the insurance company thought your injury wasn’t serious enough or didn’t require medical attention then one of two things probably happened. (1) You really didn’t need as much medical attention as the doctors gave you; or (2) you didn’t document your injury well enough. More often than not, many people forget to keep and provide all necessary medical documentation. This is why you need to keep excellent records.
When filing your claim, it’s not just a matter of filling out paperwork and informing your employer. Every time you’re at the doctor’s office, you should be keeping every piece of paper they give you. Any statement that is received, any discharge papers, any bills should all be kept to be filed with your claim. And always keep a copy of the records for yourself.
3. You Can Still Work
Disability can oftentimes be disputed if the insurance company believes that you can still work or they feel they don’t have sufficient evidence to support your claim for disability benefits. At this point, you need to be clear with your doctor and get it in writing as to what you can and cannot do physically or emotionally.
Sometimes, your claim disability benefits can be denied because the insurance carrier believes you are still capable of performing the job you had when injured, or that other jobs within the physical restrictions issued by your doctors are available in your geographic region. This is often a contested issue – whether jobs in your local community are realistically available to you, given your injuries and limitations. If you’re unable to find work despite a diligent job search, you are still entitled to make the claim for payment of compensation.
What To Do If Your Defense Base Act Claim Is Denied
Contractors and subcontractors who meet eligibility are covered employees under the Defense Base Act. Yet, your claim can still be denied for more reasons than what we have listed here. If your claim is denied or contested, you can still fight it and appeal it. At this point, it’s important to involve an attorney that focuses on the Defense Base Act if you haven’t already done so. You’ll need to provide all documentation regarding your claim and injury to your lawyer for review so they can speak candidly with you about whether the denial of benefits was justified or if not, the strategy going forward. Even if you have been paid compensation that was erroneously terminated or you were never paid benefits, your attorney will take your case to Hearing (trial) before a Judge and he/she will decide your entitlement to compensation. Even before you get to the Hearing, and depending on the evidence in your favor, you have a chance of winning an insurance settlement.
At other times, it might be that the amount of compensation is being contested by either you or the insurance carrier. You deserve a fair settlement. An experienced DBA lawyer will fight for your rights, which may include a fair settlement and the maximum amount possible without having a Judge decide your case. If you decide to fight the DBA insurance carrier’s denial of your claim or must file your claim with the U.S. Department of Labor, Office of Workers’ Compensation Programs, Division of Longshore & Harbor Workers’ Compensation Benefits and ultimately have your Hearing before the U.S. Department of Labor, Office of Administrative Law Judges.
It’s important to know that you do not have to go through this entire claim process alone. Defense Base Act claims can be confusing and cumbersome. At a time when you should be focusing on your health, you shouldn’t be worrying about whether you will receive your DBA benefits. Let the attorneys at Moschetta Law walk with you through the claim process. We focus on Defense Base Act cases, which means we’re in the best position to fight for your rights. If your claim has been denied, is being contested, or you’re in the process of filing a claim, contact our offices today. It doesn’t cost you a thing.