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What to Do if Your Workers’ Compensation Claim is Denied



Workers’ compensation is designed to provide financial support and medical care to employees injured on the job. However, sometimes claims are denied, leaving employees feeling stressed and uncertain about their next steps. If your workers' compensation claim has been denied, here are the steps you should take to appeal the decision and protect your rights.


Understand the Reason for Denial

The first step is to understand why your claim was denied. Common reasons include:


  • Insufficient evidence of the injury being work-related.

  • The injury not being reported in a timely manner.

  • Discrepancies in the medical records.

  • The employer disputing the claim.


You should receive a denial letter explaining the specific reason(s) for the denial. Carefully review this document to know exactly why your claim was rejected.


Gather Additional Evidence

To strengthen your case, gather any additional evidence that can support your claim. This can include:


  • Medical Records: Obtain complete medical documentation from all healthcare providers who treated you.

  • Witness Statements: Collect statements from coworkers or others who witnessed the accident or can verify your injury.

  • Incident Reports: Ensure you have a copy of any incident reports filed with your employer.

  • Personal Documentation: Keep a detailed journal of your symptoms, treatments, and how the injury has impacted your daily life.


Seek Legal Advice

The work injury lawyers in Denver suggest that working with a workers’ compensation attorney can be invaluable. An attorney who specializes in workers' compensation can:


Help you understand your rights and the legal process.

Assist in gathering and presenting additional evidence.

Represent you in hearings and appeals.

Negotiate settlements with insurance companies.

Many workers' compensation attorneys offer free initial consultations and work on a contingency basis, meaning they only get paid if you win your case.


File an Appeal

If your claim is denied, you have the right to appeal the decision. The process varies by state, but typically involves the following steps:


  • Request a Hearing: File a formal request for a hearing with your state’s workers' compensation board or commission. This request must be filed within a specific timeframe, which is usually stated in your denial letter.

  • Prepare for the Hearing: Gather all relevant documentation and evidence to present at the hearing. Your attorney can help prepare your case and ensure all paperwork is filed correctly.

  • Attend the Hearing: During the hearing, you will present your case to an administrative law judge. The judge will review the evidence and make a decision on your claim.


Attend Mediation

In some states, mediation may be required before a hearing. Mediation involves a neutral third party who helps both sides (the employee and the employer/insurance company) try to reach a settlement. Mediation can be less formal and less stressful than a hearing, and it can result in a quicker resolution.


Review the Judge’s Decision

After the hearing, the judge will issue a decision. If the judge rules in your favor, you should begin receiving workers’ compensation benefits. If the judge upholds the denial, you can further appeal the decision to a higher court, although this process can be more complex and time-consuming.


Consider Other Benefits

If your workers' compensation claim remains denied after all appeals, consider other sources of financial assistance, such as:


  • Social Security Disability Insurance (SSDI): If your injury prevents you from working for an extended period, you may be eligible for SSDI.

  • Short-term/Long-term Disability Insurance: If you have private disability insurance, you may be able to file a claim.

  • State Programs: Some states offer additional benefits for injured workers who do not qualify for workers' compensation.


Stay Organized

Throughout this process, it’s crucial to stay organized and persistent. Keep detailed records of all communications, filings, and evidence. Follow up regularly with your attorney and the workers’ compensation board.


Having your workers’ compensation claim denied can be a frustrating and overwhelming experience. However, by following certain steps, you can improve your chances of a successful outcome. Stay informed about your rights, and don’t hesitate to seek professional help to navigate this challenging process.

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