How To Appeal A Denied Workers' Compensation Claim

If you get an injury at your workplace, you are legally entitled to get some benefits, such as compensation for the days you are unable to work and medical bills incurred. You can access these benefits by filing a workers' compensation claim and attaching all the required documents. However, your claim can be denied due to several reasons including failing to file it on time or your employer disputes that you were injured at work. If you receive a denial letter, you can appeal the decision by following the steps described below.

Contact your employer or their insurance firm

The first step of your appeal is to contact your employer or the insurance firm that oversees matters relating to workers' compensation. You need to set up a meeting to discuss the reasons behind the denial. At times, the denial can be as a result of an error in your paperwork or failure to provide required documents, such as medical records. Getting to know the reasons behind the denial will guide you in the next step. For instance, if it was just a missing document, you can resubmit your claim and attach it. After knowing the reason behind the denial, make sure you ask your employer's insurance carrier to reconsider their decision.

Filing an appeal

If you fail to resolve the denied claim dispute with your employer, then you need to file an appeal. The denial letter will usually have a deadline for filing an appeal as per the guidelines provided by your state laws. You must adhere to this deadline for your appeal to be considered. It is important to hire a workers' compensation lawyer to take you through this appeal process. The lawyer will file an, "Application for Adjudication of Claim," to challenge the decision to deny the claim.

Review of the claim

Depending on your state, your appeal will either be evaluated by a review board or presented to an Administrative Law Judge (ALJ). Your experienced workers' compensation attorney should represent you during this review, which is similar to court proceedings apart from the absence of a jury. Your attorney will come in handy during this step because they will have looked at the reasons behind the denial and prepared adequately to counter them. If your claim was denied on the basis of the medical issues, your attorney will have an independent medical specialist evaluate your injury or review your case with the medical provider so that they can draft a more detailed report. The attorney will also contact witnesses present during your injury to corroborate your testimony to ensure the board or judge rules in your favor.

Hiring a workers' compensation attorney is important when appealing a denied claim. You do not have to worry about the attorney's fee because it will be based on a small percentage of the claim benefits you will receive.        

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