How to Appeal an Unfair Workers’ Compensation Ruling

Receiving a notice of denial of your claim for workers’ compensation benefits can be devastating. You’ll probably wonder what comes next — how will I replace my lost wages for the time I was off work, and how will I pay those outrageous medical bills? 

When you file a workers’ comp claim, the odds are often stacked against you. Your employer and its workers’ comp insurance carrier have the savvy, knowledge and resources to explore all avenues for denying your claim. After all, paying a claim represents an additional expense for the insurance company, and your employer may have to absorb a portion of the cost in the form of higher premiums. 

Determine the Reason for the Denial 

When you receive your notice of denial or reduction of benefits, the notice must state the reason for the adverse action. In some cases, your employer may have a legitimate reason for denying your claim — perhaps you didn’t report the accident within the required timeframe or failed to seek treatment for your injury or illness from a company-approved physician. 

However, in many situations, the employer is on less solid ground. For instance, your employer may attempt to state that your injury or illness is not work-related or that it is not severe enough to warrant time off from work. Trying to resolve these issues by contacting your employer or insurance carrier directly to discuss the matter is often an exercise in futility. 

You Have the Right to Appeal a Denial or Unfavorable Determination

Fortunately, an adverse decision regarding your workers’ comp claim does not necessarily indicate the end of the road. In addition to stating the reason for the action, your denial notice will also inform you of your right to appeal the decision. In many situations, the appeal process can ultimately lead to a reversal or modification of the original ruling — and provide you with the full benefits you deserve under the law.

Carefully Follow the Instructions for Initiating an Appeal

Be sure to review your denial of benefits notice closely, as it will provide an overview of the steps involved in the appeal process. The procedure varies from state to state, although most states feature a multi-tiered system — if you are unsuccessful at one stage, you can take your case to the next level until all avenues are exhausted. Pay close attention to the timeframes mentioned in the notice — you may only have a matter of days to initiate the appeal process. A late filing or missed deadline could bring your case to a halt.

Contact a Workers’ Comp Attorney Right Away

The best course of action when receiving a notice of an unfair ruling is to contact an experienced workers’ comp attorney as soon as possible. Your attorney can help you navigate the complex appeal process, increasing your chances of a favorable outcome.

If you’re in Kansas or Missouri and need help with a workers’ comp appeal, you can count on Phalen Law Firm to provide expert legal guidance every step of the way, starting with a free consultation.

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October 15, 2019