Workers' Comp Denied? Here Are Your Next Steps
Workplace injuries are generally covered by an employer's workers' compensation insurance. Many states require employers to be covered in accordance with the average level of risk for that particular industry. But if your claim for workers' comp is denied, you still have options. You may be able to appeal the denial through your state's board of workers' compensation. However, there are a variety of reasons why a claim may be denied.
This article will help you figure out what steps to take if your claim for workers' comp is denied, although specifics will vary by state. See FindLaw's Workers' Compensation Basics section to learn more.
Why Workers' Comp Claims are Denied
If your claim for workers' comp was denied, the first thing you need to do is determine the reason why. This should be explained in the denial letter. You could be denied for simply not meeting the eligibility requirements, such as getting injured while engaging in "horseplay" or while away from work. But if you believe the denial was reached in error, you may appeal. Common reasons for a denial of workers' comp benefits include (but are not limited to) the following:
- Injury was not reported in time: State laws determine how soon you must report an injury to your supervisor, typically within a few days (in Colorado, employers must be notified in writing within four days)
- Claim was not filed in time: State laws also determine deadlines for filing an initial claim, typically 30 to 90 days
- Employer disputes claim: Your employer may claim the accident happened outside of work, was the result of horseplay, or some other disqualifying reason
- Injury is not compensable: Claims for stress-related injuries, for example, are very difficult to prove in many states (in contrast, California specifically covers stress-related injuries)
- No medical treatment: In most cases, you must obtain medical treatment in order to receive workers' comp benefits
- Insufficient evidence that injury is work related: It's not always clear whether an injury happened at work, but another medical exam and additional evidence may help your case
There are plenty of other reasons why your workers' comp claim may have been denied.
Appealing a Workers' Comp Denial
Now that you know why your claim was denied, you may want to appeal the decision. The denial letter should provide a deadline for filing your appeal, which is determined by state law. In Maryland, for example, you must file your appeal within 30 days of receiving the letter of denial. Before you launch an appeal, though, you may want to meet with your employer (or its insurance carrier) to determine whether the dispute is easily resolved. It could be a clerical error or a simple misunderstanding.
If you still want to appeal the decision, bear in mind that it can be a complicated legal process best handled by an experienced workers' comp attorney. The appeals process varies by state, but often involves a hearing before an administrative law judge, either through the labor department or state workers' compensation board. There may be multiple levels of appeal, but check your state's laws for specifics.
You will want to bring any documentation, including medical records that address the reason(s) for the denial. This could be the results of a second medical examination, a time sheet showing that you were working at the time of the injury, or other evidence. If you plan on appealing, though, make sure you fully understand the procedures in your state. See the instructions for appealing a decision with the Pennsylvania Workers' Compensation Appeal Board for an example.
Get a Free Initial Review of Your Workers' Comp Appeal
Was your workers' comp denied? You may feel deflated by the denial letter, but don't despair. Your denial may be successfully appealed in many cases, but you'll probably want to work with an experienced workers' compensation attorney. Accepting a denial of benefits can be financially devastating, so have a workers' comp lawyer provide an initial evaluation of your claim today at no cost.