Can Workers Comp be Denied for Missing a Doctors Appointment?

If you receive an injury, you are entitled to receive Workers’ Compensation if the issue is work-related. In return, the Workers’ Compensation Board requires you make and keep appointments with their doctors and other medical professionals. It is very important you attend these appointments. Failure to do so means you can be denied Workers’ Comp.

What To Expect If You Miss A Doctor’s Appointment

If you miss a mandated doctor’s appointment, the Workers’ Compensation Board or Agency has the right to stop your payments. In turn, you have the right to defend your actions. Workers’ Compensation legislation allows you to do so under specific circumstances or in certain instances. In most states, missing a designated doctor’s appointment is acceptable if it is the result of “good cause.”

Good cause, in legal terms, refers to a substantial and legally acceptable reason for doing or, in this case, not doing something. For example, if you had a heart attack, this would be good cause to miss the mandated doctor’s appointment. If you were in a car crash or trapped in traffic by a car crash, this may be good cause. If you were late in leaving home, missed the bus or slept in, this is not good cause.

If you believe you have good cause, you can request a hearing. The Hearing Officer will arrange the date for your hearing. Next, set about ensuring you make your case.

The Hearing

A hearing will take place in front of an Administrative Law Judge (ALJ). He or she is a judge appointed by the State Comp Board. The ALJ will hear the case. He or she will read over the documents submitted by both parties before hearing their case in court.

There is no jury. The ALJ is responsible for arriving at a decision. This includes the court ruling and whether or not you can be denied Workers’ Compensation considering the situation. You will need to supply documentary evidence to support your case. You will also require sufficient arguments and proof if you wish to win.

The hearing will begin with the ALJ encouraging each party to arrive at stipulations – matters upon which neither party has a dispute – in this case a missed doctor’s appointment. Both parties will then present their evidence. The injured worker will provide his or her defense. The insurance company their arguments. The judge will have the final say.