A workers’ compensation claim may be denied for several reasons, including missing paperwork, disputes over the injury, or missed deadlines. When a claim gets denied, employees have the right to appeal. Understanding the appeals process helps injured workers take the necessary steps to receive benefits.
Reviewing the denial letter
After a claim is denied, the insurance company sends a letter explaining the reason. This letter provides important details, including deadlines for filing an appeal. Carefully reviewing this information helps workers understand what to correct or challenge in their appeal.
Gathering supporting evidence
Strong evidence increases the chances of a successful appeal. Workers should collect medical records, doctor’s statements, witness testimonies, and any documentation proving that the injury happened at work. A detailed explanation from a physician can help address any concerns about the severity of the injury or its connection to job duties.
Filing an appeal
Each state has specific deadlines and procedures for appealing a denied workers’ compensation claim. The process typically involves submitting a written request to a state workers’ compensation board. Some states require a formal hearing request, while others allow a review of the claim without a hearing.
Attending a hearing
If a hearing is required, an administrative law judge reviews the case. Both the injured worker and the employer (or insurance company) can present evidence, call witnesses, and provide testimony. The judge examines the facts and determines whether the claim should be approved or remain denied.
Further appeals options
If the judge upholds the denial, workers may have additional options. Many states allow further appeals to a workers’ compensation appeals board or even state courts. Each level of appeal requires meeting strict deadlines and presenting new or stronger evidence.
Seeking legal guidance
Appealing a denied claim can be complex. Consulting a workers’ compensation attorney helps employees understand their rights, meet deadlines, and present a strong case.
