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What to know about appealing a workers’ compensation claim denial

May 20, 2024 |

When you’re injured on the job and are unable to work, your financial losses can devastate your stability. After all, you’ll lose wages, and your medical expenses can quickly exceed your insurance coverage limits. As a result, you might be left struggling to figure out how to get by, secure the care you need, and get back to work.

The good news is that the workers’ compensation system might provide some relief. If you can demonstrate that your workplace injuries were suffered on the job, that you were in fact an employee, and that a medical professional has confirmed your diagnosis, then you should recover compensatory benefits to help offset your losses.

Although that may sound simple, the reality is that workers’ compensation claims are denied all the time. If that happens to you, don’t make the mistake of thinking that you’ve exhausted your options at that point. Instead, carefully think through how to position yourself for a successful workers’ compensation appeal.

What to know about the workers’ compensation appeal process

If you want to appeal your workers’ compensation claim denial, then you need to take swift action. Appeals must be filed within 14 days from the date that you receive your decision, which requires you to fill out a specific appeal form and properly submit it. Once you’ve done that, then you can start navigating the three levels of the appellate process, which includes the district, staff and commission levels.

At each level, you’ll have an administrative hearing within 45 days of your notice of appeal. These hearings are less formal than civil court proceedings. At each level, a decision must be rendered within seven days. However, the commission doesn’t have to agree to hear your case. If you’re denied at all three levels of administrative appeal, then you can petition to have your case heard in civil court.

How to prepare for your administrative hearings

At each stage of the appellate process, you’ll have the opportunity to present evidence that supports your case. Therefore, before heading into your administrative hearings, you should have the following prepared and ready to present:

  • Medical evidence, including your medical records and any opinions provided by your doctor.
  • Written statements from witnesses who observed your workplace accident and the extent of your injuries.
  • Medical bills that you’ve incurred.
  • Your own testimony about the accident, your injuries, and your need for treatment, making sure to speak to the timing of your injury and your lingering symptoms.
  • Counterarguments that challenge your employer’s defense.

The more thorough you can be the better. Also, make sure you understand why your claim was denied in the first place. This will provide guidance as far as how to target your arguments in your administrative hearings. You can also seek a second medical opinion if you feel like having that additional support will better set you up for success.

Don’t miss out on the workers’ compensation benefits you need

There’s a lot at stake when you pursue workers’ compensation benefits. And if you put forward haphazard arguments, then you’re bound to be denied the financial support that you need and deserve.

So, before engaging in the appellate process, make sure you understand what it entails and how to build effective legal arguments. That way you can rest easy knowing that you’ve done everything possible to protect your interests and maximize your chances of finding the support necessary to secure medical care and reclaim your life.