What Can I Do If My Workmans Comp Claim Is Denied?

"Workmans comp claim denied." These are words no one wants to hear after they have been injured at work. After all, workman's comp is a system that is supposed to protect workers. In fact, under the law, it is your only means of recovering compensation from a work injury since you are not permitted to file a personal injury lawsuit against your employer. As such, if your workers compensation claim was denied, you should immediately begin taking proactive steps to help rectify the situation. So, what can you do with a denied workman's comp claim?

When a Workers Comp Claim is Denied

The first thing you want to do is find out why your claim was denied

Perhaps the situation is something that can be rectified simply, such as the fact that you forgot to include a statement from your doctor regarding the nature of your disability. If so, gather the necessary paperwork and resubmit the application, hopefully to be approved next time.

You want to file an appeal with the worker's compensation insurer

This in-house appeal is always the first step. In some cases, you may have as little as a 30 day window of time to file the appeal following receiving a denial of benefits notice. This means you should not wait to appeal- if you wait and miss the deadline, you may be barred forever from appealing your case.

If that appeal is denied, contact the worker's compensation board

Every state has some type of workman's compensation board that oversees the worker's comp program. This is an administrative board, created as part of the workman's comp act passed by the legislature. Their sole function is to administer the workers comp program, and a big part of doing this is hearing appeals from denied claims.

Depending on your state, there may be several stages of appeal that you need to go through. For example, you may need to first file a written appeal which is reviewed. You may then need to schedule a hearing and appear before the administrative judges. Typically, your appeals are limited to this workers comp board, which means you don't get to appeal in court. In some limited cases, after appeals have been repeatedly denied, you can appeal to an appellate court- however, that court will generally only review the decision of the worker's comp board for procedural problems, not for a determination on the facts.

Getting Help

As soon as you receive notice of a workmans comp claim denied, you need to consult with an experienced attorney. Your attorney can help you to understand what the rules are regarding appeals in your state and can assist you in the process of filing an appeal that is more likely to be successful and get you the benefits you deserve.

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