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Appealing Your Denied Workers Compensation Claim: What You Need To Know

Being denied a workers compensation claim can be a frustrating situation--especially if your work-related injury has rendered you unable to work or led to expensive medical bills. However, if you've received a denial letter for your workers compensation benefits, understand that this doesn't have to be the end; by appealing your workers compensation denial and following the right set of steps, you may very well be able to have the decision overturned.

Understand the Reason for Denial

Start by making sure you understand the reason for your denial; this should be outlined in detail in your official denial letter. Your reason for denial could be as simple as a missing piece of paperwork or an administrative mistake made on your employer's end. If this is the case, contact the insurer and ask if they'll reconsider their decision once the proper paperwork is filed or other mistakes are corrected. If so, you may not even need to go through the formal appeal process.

File a Formal Appeal With the Insurer

If things are a little more complicated than a missing form or an innocent mistake, then you'll need to file a formal appeal. Understand that states can differ in regards to the different levels of appeals; more than likely, you'll need to start at the administrative level, which will mean filing your appeal with the insurance company that denied your claim. Inquire with them as to what steps need to be followed to complete your appeal. You'll need to work quickly, though, as most states have strict regulations in place regarding how long you have to file your appeal.

Contact a Workers Compensation Attorney

Don't go through the appeals process alone. Now is a great time to contact a dedicated and experienced workers compensation attorney to walk you through the process. An attorney can help strengthen your case and prepare you for your appeals hearing. For instance, he or she will help to ensure that all your paperwork is submitted in a timely manner and that you know what to say in court.

Continue Working Up the Appeals Ladder

If your administrative-level appeal is denied, you're not completely out of luck just yet. Your workers compensation attorney can help you figure out where to go next for a higher-level appeal--typically moving to the state board of appeals Beyond that, you may even need to file an appeal at the Federal level.