What To Do if Your Workers' Compensation Appeal Is Denied

Proving your workers’ compensation case can be difficult. Sometimes, your claim results in a denial, and you must appeal the outcome. This can be challenging without an experienced workers’ compensation attorney helping you through the appeals process. A lawyer can help you understand the reasons for your denial and how to address those issues in later appeals.

A workers’ comp lawyer experienced in your state’s workers’ compensation laws can provide the legal advice you need. Contact a lawyer today.

Understanding the Reasons for Denial

If your workers’ compensation claim appeal is denied, you must understand the reasons for the denial. Understanding the common reasons for a denial of workers’ compensation benefits helps you navigate the appeals process. You can be prepared to address any deficiencies in later appeals.

Common reasons for workers’ compensation claim denials include the following:

• Submitting incomplete or inaccurate paperwork when applying for workers’ comp benefits
• Filing your workers’ compensation claim for a non-work-related injury
• Filing a workers’ comp claim for a pre-existing condition
• Reporting your workplace injury to your employer after the period required by your state’s workers’ compensation system
• Making claims for medical conditions or personal injuries not covered by workers’ compensation insurance in your state
• Receiving medical care from an unauthorized provider
• Failing a drug or alcohol test administered immediately after the workplace injury occurs

You may have received a claim denial for several reasons. Understanding why your claim is denied can inform you of your next steps.

Understanding Your Options After a Workers’ Compensation Appeal Denial

If you received a denial of your claim, you’ve probably gone through several steps at this point. While the particular steps depend on your state’s workers’ compensation system, they likely included the following:

• You made a workers’ compensation claim and received a denial.
• You filed a formal claim for an application adjustment of the claim with your state’s workers’ compensation board or workers’ compensation commission.
• The board may have assigned your case to informal dispute resolution.
• Your case may have been assigned to a hearing before an administrative law judge if you did not reach a resolution.
• Both you and your employer or the employer’s insurance company could present evidence and witness statements. This includes medical evidence and medical expenses.
• After the hearing, you received a decision on your workers’ compensation claim.

Like the claims process, the appeals process is a formal procedure that requires attention to detail. You can file a new appeal if you receive a denial of your appeal.

Staying Organized and Proactive

We all hope that claiming workers’ compensation benefits will be a quick and smooth process. Sometimes, it’s not. A denial letter means that your case will take longer to resolve before you receive any benefits. In such cases, staying organized through the appeals process is critical.

You’ll want to keep excellent records of your case, including:

• Records of medical treatment
• Medical bills
• Witness statements
• Accident reports

Strict deadlines govern every step of the appeals process. You must adhere to these deadlines, or you could lose the right to contest the appeal denial. Staying on top of the deadlines demonstrates your commitment to your case. This can be viewed favorably by your case reviewers.

Depending on your state’s rules, you may need to file more paperwork to prepare for a new workers’ compensation appeal.

Filing a New Appeal

When you receive a claim denial after the appeal hearing of your claim denial, you can appeal to the full commission within the timeframe required by law or the commission’s rules.

A workers’ compensation appeal is appropriate if you disagree with the full commission’s decision. You can appeal to the appellate court in your state.

If the court of appeals rules against you, you can petition your state’s highest court, the Supreme Court, to take your case. Most cases will require a lawyer’s help to navigate the complexity of an appeal at this level.

Contact a Workers’ Compensation Lawyer

If you need help with your workers’ compensation claim denial or appeal, contact a local workers’ compensation lawyer for a case review. Many workers’ compensation attorneys offer free case evaluations. Entering a client relationship with a workers’ comp attorney means you will receive legal advice specific to your situation. They can explain all your legal options for appealing your workers’ comp denial.