The Process of Appealing a Workers’ Compensation Denial

Workers’ compensation benefits are meant to help individuals injured or suffering from an illness that resulted from their employment. The benefits pay for medical expenses related to the injury, and in the event of an employee missing work because of the injury or illness, the employee can collect disability payments that pay a percent of the employee’s wages while they are unable to work. The program gives employees the ability to access these benefits, even in the absence of the employer’s fault. In exchange for this program, employees lose the right to sue their employer in a court of law under most circumstances. Given how important workers’ compensation benefits are to injured employees, it can be very frustrating for an employee who is ill or injured to be denied coverage. This scenario is not uncommon, and it is important to know that a denial is not final. In most cases, there is a right to appeal the decision.

Appealing a denial of workers’ compensation benefits

Much like the initial claim, when it comes to filing an appeal for workers’ compensation benefits, time is of the essence. While the time an employee has to appeal varies by state, it is usually a relatively short window.

The first step of the appeal is likely going to be a hearing in front of an Administrative Law Judge (ALJ). At the hearing, you will be expected to provide detailed and complete medical evidence of your injury or illness, and of the fact that the injury or illness that you suffered resulted from something you did during the course of your job.

In addition to procedural issues, such as not filing a claim on time, frequent reasons initial claims are denied include a lack of medical evidence suggesting that your injury exists or that it is as serious as you claimed, a belief that the treatments you underwent were unnecessary, and doubt that the injury or illness you suffered was actually caused by your work. The denial of your claim might have given an explanation as to why your claim was not approved. You will likely need evidence to contradict the reason that you were denied coverage. This will mean medical records, statements from your doctor, and possibly evidence from witnesses who can attest to your injury being caused by something related to your job.

If your claim is still denied by the ALJ, there are likely additional steps you may take to appeal your case to another level. These steps will be different though depending on which state you live and work in.

You should speak to an attorney

Many individuals file their initial claim for workers’ compensation on their own without the assistance of an attorney. However, once your claim has been denied, you should consider finding an attorney who can represent you and walk you through the process of appealing a workers’ compensation claim in your state. Your attorney can review your file and look for any gaps or weaknesses in your medical charts and records so that you can go into the hearing with a complete file.  Your attorney can also prepare you for what to expect at the hearing and what questions you will have to answer. This can save you from going in nervous and unprepared and giving answers that are not well thought out. Having an attorney on your side gives you an experienced advocate who understands the process of the appeal and can help work with you and your individual case and your states specific laws in order to pursue the benefits that you were denied.

Given what is at stake, be sure to fight to get the support that you need and that you are entitled to. Also, remember that your employer cannot legally retaliate against you for filing a workers’ compensation claim.

Contact Stern Law, PLLC for A Free Consultation

At Stern Law, PLLC, we have compassionate and caring attorneys ready to work with you in order to find the best strategy for seeking compensation for your job related injuries. Contact Stern Law, PLLC today at (844) 808-7529 for a free consolation with an experienced attorney.

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