After denying a workers comp claim, you need to hire an attorney. Overcoming the denial involves presenting compelling evidence and arguments, a challenging task, particularly when pitted against the formidable legal representation employed by insurance companies. Having your attorney levels the playing field and enhances your chances of appealing for workers comp benefits.

If you’ve suffered a work-related injury or developed a job-related medical condition, like a repetitive strain injury or an illness from workplace exposure, you likely expect to qualify for workers’ compensation benefits. However, if your workers compensation claim faces denial, your next steps hinge on the reasons behind the rejection.

Common Reasons For Denial Of Workers’ Comp Claims

Employers and their insurance companies often seek grounds to deny workers’ compensation claims, subject to the legal validity of their reasons. Common factors leading to claim denials encompass:

  • Missed Deadlines: Timely reporting injuries or illnesses is crucial for workers’ comp eligibility. Failing to adhere to state-specific deadlines for reporting and filing worker compensation claims may result in denial. Some states may not penalize missed reporting deadlines if the employer is aware of the incident, but filing within the stipulated time frame is still essential.
  • Disputes on Work-Relatedness: Employers may dispute the connection between the injury and work, citing factors such as non-working status during the incident, alleged misconduct, or questioning the workplace origin of the medical condition. Resolving these disputes may require gathering evidence, including witness accounts and additional medical documentation.
  • Failure to Meet State Guidelines: Workers comp laws may impose specific restrictions on workers’ comp claims for conditions like cumulative trauma or psychological injuries caused by workplace stress. In such cases, the severity of injuries must meet state-defined criteria for a successful workers’ comp claim.
  • Claim Filed After Job Termination: Insurers commonly deny claims submitted after an employee leaves their job due to firing, layoff, or resignation. Exceptions may apply if the injury was reported during employment, occurred after notice but before departure, or if the termination was retaliatory for reporting an injury (illegal in some cases). State laws may have provisions allowing exceptions, enabling employees to contest denials if they qualify.

How Do You Appeal a Workers’ Comp Claim Denial?

The appeal process is your next avenue when faced with a denied workers’ comp claim. Typically, this involves these steps:

  • Understand the Denial: Carefully review the denial letter to understand its reasons. Knowing the specifics is crucial for your appeal.
  • Contact the Claims Adjuster: If it seems like a misunderstanding or paperwork issue, communicate with the adjuster. However, this may not work if the denial is based on substantial grounds.
  • Gather Evidence: Collect all relevant evidence supporting your claim. This might include medical records, witness statements, or any documentation proving your injury’s work-related nature.
  • Consult with an Attorney: Seeking legal advice is wise. An experienced workers’ comp attorney can guide you through the process, ensuring you cover all necessary aspects. ( Learn more about when to hire a workers compensation lawyer) 
  • File an Appeal: Submit an appeal to your state’s workers’ comp board or commission. This involves completing specific forms and providing the gathered evidence.
  • Attend a Hearing: Be prepared for a hearing where you present your case. Having legal representation can significantly bolster your chances.

Remember, the appeal process varies by state, so following your state’s specific procedures is essential.

Deadlines for Filing Your Workers’ Comp Appeal

When appealing a denied workers’ comp claim, adhering to deadlines is critical. The exact timelines can vary by state, but generally, you must file an appeal within a specified period after the denial. This period often ranges from 30 to 90 days. 

Missing these deadlines could jeopardize your ability to challenge the denial, so acting promptly and staying informed about your state’s specific timelines is crucial. Seeking legal guidance can ensure you meet these deadlines and navigate the appeals process effectively.

Want To file An Appeal? Contact a Worker’s compensation lawyer

Seeking guidance from a workers’ comp attorney is crucial when considering an appeal. The intricacies of the appeals process, involving legal nuances and strict timelines, demand expertise. 

They can assess the merits of your case, guide you through the complex legal procedures, and help prepare a robust appeal. Missing deadlines or navigating the legal complexities without proper representation may jeopardize your chance to secure benefits.