My Claim was Denied. Can I Appeal It?

If you have suffered an injury while at work or you have become sick because you came into contact with a hazardous substance while on duty, you may be eligible for workers’ compensation benefits. Workers’ comp is insurance that most U.S. employers have to protect their employees while they are at work.

It can help workers recoup costs for medical expenses and wages that are lost because they are unable to work because of the injury.

Filing the Workers’ Comp Claim

Filing a claim involves gathering the proper paperwork, including a copy of the accident report that was completed by your employer. The forms must be completed in detail with all questions answered.

Making sure you have clearly documented what happened and how you were injured or what made you ill so the insurance company will understand why you are filing a claim and they and they can better determine if you are eligible for benefits.

If Your Claim Has Been Denied

If you receive a letter that notifies you your workers’ compensation claim has been denied, you need to read it carefully to determine why the insurance company denied your claim. Claims can be denied because the claim was not reported in a timely fashion.

State law requires that the injured worker report the injury within a specified timeframe, which is often a matter of dates. The employer is required to inform their workers’ comp insurance carrier and state in a timely manner as well.

Sometimes the employer will dispute the claim because they don’t believe the accident happened while you were on the job or they may not believe your injury or illness is the result of what happened at work. There are many reasons that an insurance company or an employer may deny a workers’ comp claim.

However, you can file an appeal and provide additional evidence to support your claim and your account of what happened.

Filing an Appeal

While an appeal involves presenting additional information and evidence to support your claim, it can be a complicated process that requires the support of a workers’ comp attorney. Because each state sets its own workers’ comp laws, the process can vary from state to state.

Your denial letter should include the deadline for you to file your appeal, so you need to make sure you have filed your appeal by that date.

In some states, you meet with your employer or its workers’ comp insurer before filing an appeal to see if the dispute can be settled because of a misunderstanding or a clerical error.

The appeals process can be complicated and will most likely require the guidance of a workers’ comp attorney as most appeals end up at a hearing before an administrative law judge, who will make a ruling on your claim.

The appeals process may have multiple levels, but you will need to provide any medical records and evidence that address your case. You may even need to supply a second doctor’s opinion as well as copy of your timesheet showing that you working at the time of the accident.

In order to file an appeal, you should understand the process in your state by consulting with a workers’ comp attorney. A workers’ comp attorney can handle the entire process from the initial filing to any appeals and settlement negotiations.