An Overview Of The Workers' Compensation Appeals Process

22 July 2019
 Categories: , Blog

In most cases, hurt workers can use their employer's insurance for a short time and then return to work. Unfortunately, some workers end up having their legitimate claims for benefits denied. To get an idea of what can happen after a claim is denied, read below for a list of actions you will need to take in order to pursue your claim to the end of the line.

Ask for a Reconsideration

Claims can be denied for all sorts of reasons. Take a look at the reason provided in the letter from the workers' compensation insurance company and identify the potential to make things right. For example, if it appears the claim was denied due to an error, you may be able to have the claim reinstated by correcting the issue. Don't hesitate to call the insurance representative and find out more about the reason for the denial. You may have the opportunity to fill out a new claim form and refile it.

Ask for an Appeal

If you are unable to get things straightened out with the carrier, you are entitled to file a request for an appeal. Caution is urged since the deadline for filing an appeal can be short. Be sure to follow the instructions for submitting the appeal carefully and supply all requested information to the carrier. As a side note, having a claim denied usually calls for getting a workers' compensation lawyer to help you with your appeal.

Participate in Mediation

Conflict mediation is a must in most cases and you usually have no choice but to participate. Usually, meetings are attended by you, your lawyer, the insurance company's lawyer, and a neutral third-party professional mediator.

Attend the Formal Hearing

It's called a formal hearing for a good reason. Usually overseen by an administrative law judge or an employee of the state worker's compensation board, the proceedings are remarkably similar to that of a courtroom case. Testimony is provided by you, medical professionals, vocational experts, and more. The point is to show that the original claim was improperly denied.

Ask for Another Appeal

You are entitled to have your original appeal hearing examined for mistakes but you cannot introduce new evidence at the second appeal. Not all states employ the second appeal.

Sue the Employer and/or the Insurance Carrier

In certain situations, you can file suit against certain parties using civil court procedures. Speak to a workers' compensation lawyer to find out more about the appeals process and taking your case to the endpoint.