Work Compensation Claim: The Appeals Process

If you’ve filed a workers compensation claim, and had it denied by the insurer, you’re probably in one of the most frustrating situations you can imagine. Not only are you injured and losing money – to medical bills as well as by being unable to work – but you’re also now being told that your work-related injury won’t be paid by your employer and you’re responsible for it yourself. It’s a stressful situation to be in. The good news is that it is possible to appeal the denial, provided you’re willing to do some work and follow through on the process. At this point, you’ve probably put in quite a few hours making your case and gathering required information, so it’s worth another try and a bit more effort to file an appeal, even if it seems difficult.

The Workers Compensation Claim Appeals Process

The basic steps below will get you started on the appeals process; details will vary by state, so you should make sure you know the procedures in your specific location, but in general this will help you know what to expect.

  • Get a lawyer if you don’t have one already. While you may have made it through the initial hearing without a lawyer, that might very well have contributed to your denial. Honestly, no matter how simple your case or how much you know about it, you shouldn’t forget that the insurance company has several lawyers on their side, and you shouldn’t take this on by yourself. A qualified injury lawyer will know things that may surprise you – and help you.
  • File the appeal. Move quickly, since there’s typically a time limit on how long you have to file after the initial decision. You will have time after you file and before the hearing to prepare.
  • Re-assess your case. Your claim was denied for a reason, which hopefully was explained to you. Go back over your case and find or clarify the information that seemed to cause your case to be denied. This is, again, where a lawyer will be invaluable. You will need all the evidence and information you had the first time around, plus more, during your appeal The good news is that much of the work is done already; the bad news is, you have more to do.
  • Go through with the hearing. The workers compensation appeals board in the state where you live will hear your case- this doesn't occur in front of a courtroom judge, as the workers comp board is the administrative board vested with the power to make decisions on workers compensation claim cases. 

If you are denied again, you can keep appealing, although there may be a point where either you have to admit your evidence isn’t supportive enough, or the time and money consumed by appealing will be more than what the case is worth. However, if you have a genuine argument and you’ve presented it clearly with plenty of supporting evidence, the appeal may just pay off, and your claim will be accepted, in which case you’ll be able to move on with your life. 

Getting Help

Worker’s compensation is no substitute for your health and well-being, but if you’ve been injured on the job the least you can expect is fair treatment. If it requires an appeal or two in order to get it, it’s more than likely worth the effort. By getting assistance from a qualified lawyer, you can maximize your chances that your appeal will be successful and that you'll be able to collect the benefits you deserve.

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