How To Appeal A Denied Workers' Compensation Claim

Work injuries are common. Which means so are workers’ compensation claims. In general, the workers’ compensation system is designed to provide certain benefits to workers injured while working. And they do not need to prove negligence fault by their employers or their coworkers. Simply the act of injury is enough. However, when these injured workers are denied their workers’ comp claims they can appeal the decision.

Reasons for Workers’ Comp Claim Denial

There are a few different reasons a workers’ comp claim is denied, which means you do not get the benefits you deserve. Here are some common reasons why the workers’ compensation claim might have been denied:

  • Injury did not occur while performing the job.
  • The injury was caused by a preexisting injury or condition.
  • A dispute as to when or where the injury occurred.
  • It was concluded by a health provider that you were not disabled as a result of the work injury.
  • Dispute whether there was an injury sustained at all.

These are the most common reasons for a workers’ comp claim denial. You can have other reasons for the denial. If these, or any other reasons, led to the denial of the claim and you’d like to file an appeal, our law office can help! We can go over the steps you need to take to properly file an appeal.

Steps to Appeal the Decision

There are different methods of appealing the denial of your workers’ compensation claim. However, there is a few things everyone can do when seeking review of a previously denied workers’ compensation claim:

  • Learn why your benefits were denied by contacting the insurer directly. Sometimes it was something simple, like failing to provide a specific document.
  • You may ask the insurer if they will reconsider the decision. Hey, you never know.
  • File a formal appeal within the stated timelines.
  • Hire a workers’ compensation attorney (like us!) to handle the appeals process.

What Your Work Injury Attorney Can Do

When you turn to us as your workers compensation attorney, we can help you with the appeals process for a previously denied claim. We will determine the reason for the denial in the first place. Then, we will gather documentary evidence, contact any possible witnesses, and, if necessary, retain experts from the medical field and your industry. So you can trust us to lift every stone possible in order to win your workers compensation appeal.

In our experience, most claims are denied based on medical issues. Due to this knowledge, we may have your injury or disability evaluated by an independent medical specialist. Or we will review your case with your present health care provider to determine if a more detailed medical report needs to be done. We will also determine if any additional proof is needed to demonstrate a disability or directly related injury.

Our law firm will also handle the entire appeals process. So whether you have a review board or need the appeal heard in court, our work injury lawyers will make sure everything is done in order. These hearings in front of an administrative judge are similar to trials. However, there is no jury and the rules allowing certain evidence may be different. Which of course we will know beforehand. During this appeals process, witnesses may be heard and we can introduce other documents as evidence for the board to consider.

If the review is denied, don’t lose hope. There is still more we can do. The next step is an appeal to the Workers’ Compensation Court of Appeals or other appeals board. When we get to this level of review, only the record of the hearing is considered. So we cannot admit new evidence and there is no hearing. The court considers only the ruling by the judge or review board and affirms, modifies, reverses, or remands the case for further proceedings or findings.

And if you think this is the last step should the appeal fail you are wrong! We can file appeal to your state’s court of appeals. So please, do not hesitate to contact us today for more information about our law firm and how we can help. If you need help with an appeal for a denied workers’ compensation claim, our law firm can help! We represent clients from across Long Island, New York and have years of experience handling workers comp claims.