What to Do If Your Workers’ Compensation Claim Is Denied

Receiving a denial for a workers’ compensation claim can be a significant setback for anyone relying on these benefits to recover from a workplace injury. However, a denial is not the end of the road. There are several steps you can take to appeal the decision and fight for your right to compensation. Here’s a guide on what to do if you find yourself in this situation.

Understand the Reason for Denial

The first step after receiving a denial is to understand why. Common reasons for denial include claims that the injury is not work-related, missed deadlines, or insufficient evidence that the injury is as severe as claimed. Your denial letter should specify the reason, which is crucial for determining how to proceed with your appeal.

Seek Legal Assistance

Navigating the appeals process can be complex and daunting. It’s highly recommended to seek the assistance of an experienced workers’ compensation attorney who can guide you through the process, help gather necessary documentation and represent you at hearings. An attorney’s expertise can significantly increase your chances of a successful appeal.

File an Appeal

Once you’ve consulted with your attorney, the next step is to file an appeal. The process and timeframe for appealing a workers’ compensation denial vary by state, so it’s important to act quickly and adhere to your state’s specific procedures. Generally, the process involves filing a formal appeal with the state’s workers’ compensation board or commission.

Gather Additional Evidence

A crucial part of appealing your denial will be to gather additional evidence to support your claim. This may include medical records, statements from witnesses, additional medical evaluations, or evidence that your injury is work-related. Your attorney can help identify the types of evidence that will be most persuasive in your case.

Prepare for the Hearing

If your appeal proceeds to a hearing, it will be similar to a trial. You’ll have the opportunity to present evidence, call witnesses, and make a case for why your claim should be approved. Your attorney will prepare you for what to expect, help develop your testimony, and argue on your behalf during the hearing.

Consider Alternative Dispute Resolution

In some cases, it may be possible to resolve the dispute without a formal hearing, through mediation or arbitration. These alternatives can be faster and less adversarial, offering a chance to reach a settlement with the insurer.

Stay Persistent

The key to overturning a denial is persistence. With the right preparation and support, many workers successfully appeal denied claims. Remember, a denial is not final, and you have the right to seek the benefits you deserve.