Reasons Why Your Defense Base Act Claim Can Be Denied
Defense Base Act claims may be denied because they aren’t valid for one reason or another, but even completely legitimate claims are sometimes subject to denial. Here are a few reasons why benefits might be denied in a perfectly valid claim:
- You missed a deadline or time limit. The time limits that apply to Defense Base Act cases are very real. If you miss a deadline, you may not be able to receive benefits—even if you didn’t know about the time limits in your case.
- You are being bullied by your employer or its insurance company. If your benefits are denied or suddenly stopped for no apparent reason, there is a chance that the denial is simply another tactic to minimize how much your employer must pay for your injury. An experienced attorney can help you determine your rights and find out why your claim has been denied.
- You don’t have enough evidence to support your claim. Unfortunately, it is often up to the injured victim to “prove” that injury benefits are deserved. Without documentation and careful preparation, even the most straightforward DBA claims can be denied.
- "Just because." This is the single biggest problem with overseas civilian contractor cases. The insurance company can either not provide initial benefits or stop your benefits for any reason whatsoever. In other words, "just because." And you know what? This happens all the time. Every day that you wait on hiring a seasoned Defense Base Act lawyer is another day you will wait for the insurance company to start back your benefits "just because."
What To Do Next?
One thing is certain - doing nothing is not the best option. If your Defense Base Act medical benefits are denied or the insurance carrier refuses to pay for your medical treatment you need to take action. Now.
Follow these steps to build your DBA case:
1. File a LS-203
File a claim for compensation with the US Department of Labor. You will need to file an LS-203. You can obtain the LS-203 from our office or the Department of Labor. Keep a copy for yourself. If you don't hear back from the Department of Labor within a few weeks of filing your claim, follow up in writing.
2. Medical Evidence
To begin the process of winning your case you need to prove that you actually need the medical treatment. Usually it will be your treating physician who prescribed the treatment. You need something from the doctor indicating such. You don't need anything really formal. A letter on the doctor's letter head in the doctor's most legible handwriting can suffice. You can show the doctor this article if you want.
Many doctors will prepare a report for the insurance company. That is great. A typed more formal letter is great also, but some doctors charge for typed written reports. However, you are not in a position to pay for the medical report. In this instance, a hand-written report can carry the day. The doctor's "report" should cover some basic points.
The doctor needs to state the treatment is related to your work injury. If the carrier is disputing you have a work-related injury the report should describe how you were injured and why it is work related. A short explanation is better than as a conclusion.
The doctor should state why they are recommending the treatment. Finally, the doctor needs to state the treatment is necessary to cure or improve your industrial medical condition.
3. Request Treatment Be Authorized
You need to request the carrier to pay for the treatment. This needs to be in writing and you need to have a copy proving this.
4. District Office
Contact your local District Office of the US Department of Labor. Send them a letter, briefly describing all of the above. Request an "Emergency Informal Conference."
5. Emergency Informal Conference Procedure
At the emergency informal conference, calmly and patiently explain all of the foregoing to the Department of Labor Claims Examiner. The employer/ carrier will state their position after you do yours.
6. Hire The Best DBA lawyer You Can Find
Representing yourself should be a last resort. You need to find a good DBA / Longshore Act attorney to represent you. As the claimant, your credibility is always at issue. When you represent yourself you can unknowingly sabotage your case. Happens all the time. Do yourself a favor - get a good DBA/ Longshore Act lawyer. Even if you don't end up hiring us, we will help you find a good home. Don't end up with a lawyer that has never practiced before the US Department of Labor. Don't be afraid to ask how many Longshore Act trials they have done. You don't want a rookie.
Disclaimer: Please understand these discussions and/or examples are not legal advice. All legal situations are different. This testimonial, endorsement and/or discussion does not constitute a guarantee, warranty, or prediction regarding the outcome of your legal matter, your particular case/ situation and/or this particular case/ situation.