Workers in West Virginia are protected by their employer’s workers’ compensation insurance in the event that they are genuinely injured while at work or become ill because of their job. A workers’ compensation claim should lead to a payment for all medical expenses as well as partial compensation for lost earnings. Insurers don’t always accept a claim and may deny it for a number of reasons. Usually, the claim denial can be appealed but it helps to have an experienced workers’ comp. attorney to provide legal representation. Workers’ Comp. Law in West Virginia Most employers in West Virginia with few exceptions must have workers’ comp. insurance, typically with a private insurer. The state agency in charge of workers’ compensation is the West Virginia Workers’ Compensation Office. In the event that you are injured, or become sick while at work, you must seek medical treatment and notify your employer as much as possible giving as much detail about the circumstances as possible. After treatment you should make a claim giving information about the treatment received. There is an official report which should be completed and signed by the doctor. Your employer is required to notify the insurer after being informed of the incident. The insurer is required to make a decision about the claim reasonably promptly, typically within 14 days. Reasons Why a Workers’ Comp. May be Denied A workers’ comp. claim can be denied for a variety of reasons. Sometimes there is a simple reason which you may be able to resolve without having to file an appeal. For example, there may be a misunderstanding about the date you say you were injured. Other common reasons given for a denial include not submitting information to your employer on time, not submitting a claim on time or not providing sufficient documentation about medical treatment. you were not injured at work; you did not use safety equipment or follow safety rules as provided by your employer; you were drunk or affected by drugs which caused the accident. How to File a Workers' Comp Denial Appeal in West Virginia You must write a letter to the Office of Judges within 60 days of being in receipt of your denial. The letter must include your name, the claim number, the date of the injury or outbreak of sickness, the date when you received the denial notice and the reason for questioning your denial of your workers’ comp. claim. When you file your protest letter you should not include a request for a hearing but this should be presented in a letter that specifically requests for a hearing. This must be done within thirty days of the denial notice. You may have to be present at the hearing and be ready to be questioned about the nature of your injury or sickness. Your employer has the right to ask you to attend a medical examination. Once you have filed your request for a hearing you will be sent a document called “Acknowledgement of Protest and Automatic Time Frame Order.” This document details any deadline for the submission of evidence to the Office of Judges. If you mail a written notice 10 days before the Time Frame finishes, ask for extra time, you will typically be offered an extension providing you explain the reason for the request. The concerned parties in this appeal are as well as yourself, your employer, and the person responsible for administrating your employer’s insurer. Once the time frame has come to an end the Office of Judges will mail you a document which is called an “Order Submitting Protest.” This document has listed all the evidence received by the Office of Judges from you, your employer, and the insurance company. It will take 3 months to reach a decision. If you case is rejected by the Office of Judges you may be entitled to appeal this decision to the Workers’ Compensation Board of Review. You will be given 30 days to do this. The Reasons for Hiring a Worker’s Comp. Attorney Winning a workers’ comp. denial can be daunting especially if you try to go through the process without the help of a workers’ comp. attorney. You should not take on an appeal on your own but you should consider hiring a workers’ comp. attorney who knows the appeal process well and will ensure you get the workers’ comp. you deserve.
