(Newswire.net — May 16, 2023) — Having your workers’ compensation case denied can be frustrating, especially when you are struggling financially as a result of your workplace injury. There are many reasons why workers’ compensation claims are denied. However, you can appeal the decision of denial of your workers’ compensation claim. Read on to learn more about how to appeal a denied workers’ compensation case.
How Will I Know My Claim Has Been Denied?
If your claim has been denied, you can find out in several ways. For example, the insurance company can send you an email or a letter informing you about the denial of your claim and listing the reasons why your claim was denied. They may also inform you over the phone.
The insurance company can also send you a Form WC-3 as a response to your claim, which means that your claim is disputed and the insurance company refuses to pay for the damages.
Another way you would know that the insurance company has denied your claim is if they stop responding and do not follow up after your claim is filed. You or your lawyer can try contacting the insurance provider to determine if there is a mistake in the paperwork you submitted that can be resolved to get your claim reconsidered. If that option is not viable, you have the right to appeal the insurance company’s decision.
Filing an Appeal
Once you receive a denial letter from the insurance company, it should include information about how long you have to file an appeal against the insurance company’s decision. The timeline is typically anywhere between 30 to 90 days, but that varies depending on the facts of the case. If you do not file an appeal within the given deadlines, you may lose your right to obtain workers’ compensation benefits.
The denial letter will also include what documents are required to file an appeal. Filing an appeal after the denial of a workers’ compensation claim is a complicated process—an experienced attorney can help. Once an appeal is filed, you or your lawyer will be notified of when the actual or virtual hearings will be conducted.
Mediation
Most states allow all parties to participate in the mediation process before the formal workers’ compensation hearing is conducted. In this process, a neutral third party helps both parties present their arguments and reach a resolution. If an agreement is reached during the mediation stage, a judge will review the agreement. However, if the parties cannot resolve the matter through mediation, the appeals process moves to a hearing.
Workers’ Compensation Hearing
Although the workers’ compensation hearing is not as formal as a trial, it still includes witness testimonies, evidence presented by both parties, and legal arguments. A judge presides over the hearing and the injured worker and their attorney present evidence to convince the judge why the initial denial of the claim was incorrect. The lawyers of the opposing party also present arguments and evidence. After that, the judge will evaluate the facts and available evidence and give a ruling. Don’t delay filing your claim, go now to an attorney to discuss your case.