Appealing a Workers’ Compensation Denial: Do You Have a Case?

workers-compensation-appeal

Do You Have a Case For Appealing a Workers’ Compensation Denial?

Last year a friend of mine was injured at work. Being an automotive technician, a lot of his work involves quite a bit of heavy lifting, and that is exactly how he was injured. This forced him to miss work for more than three months, and he had quite a few medical bills to pay, and not to mention the many trips to the hospital.

 

But, when he claimed workers’ compensation, it was denied. That came as a rude shock, but the question right now is whether he will be able to appeal and if yes, how should he go about it?

 

Reasons for Denial

There could be several reasons why your workers’ compensation claim is denied. From not reporting the injury in time to insufficient evidence for a claim, the court can deny your claim if it finds that you do not have enough of a reason for the claim.

Let us explore a few common reasons for denial:

  • If you do not report your injury on time, then you could be denied compensation. In Pennsylvania, the stipulated time is 21 days, meaning you must report your injury to your supervisor within 21 days of getting injured.
  • Your workers’ compensation claim should be filed within the time set by your state. A work injury lawyer will be able to guide you about the exact time frame if you’re filing in NJ or NY.
  • Your employer may deny the fact that you were injured at work and may claim that it happened outside of work. If you do not have sufficient proof, you may lose out on all the benefits.
  • Mental stress-related injuries (except for the state of California) are not considered under workers’ compensation in many states.
  • If your injury did not require any significant medical treatment, then the chances are that your claim may be denied.

 

How to Appeal, in Case Your Workers’ Compensation is Denied:

Unless you are a federal employee, different states have different methods to appealing a denial case. There is a specific time frame during which you need to file your appeal. But, you should bear in mind that the easiest way, if you aren’t sure of how to go about it, is consulting with an experienced workers’ compensation lawyer to review your denial and advise you on the next steps.

These are a few steps that you can take for filing an appeal:

  • You must contact your employer or the employer’s insurer to discuss the denial of your appeal. Many times there is an error in the paperwork which could have led to the denial.
  • Check if your insurer is ready to reconsider their decision.
  • You must file a formal appeal to the appropriate administrative agency within the stipulated time.

 

As the appeal process varies from state to state, there are different processes you might have to go through. Generally, the first hearing is an administrative hearing before an administrative law judge. You must keep all other documentation, like second medical opinions, time cards, and any other evidence that supports your appeal ready.

 

You should not concede defeat on the basis of the denial letter because it is not the end of the road. A work injury lawyer will be able to guide you and let you know if an appeal is the best course of action for you, as well as help you prepare for it. Since appeals are quite complex legal procedures and involve various time limitations in addition to loads of paperwork, it is best to have a competent work injury lawyer file the appeal on your behalf.

 

Finding the Right Attorney

A workers’ compensation hearing can be stressful. Choosing an attorney with considerable experience in handling workers’ compensation appeal processes will help you to get a decision in your favor.
The attorneys at Goldberg & Wolf can help you with your workers’ compensation case. Our dedicated legal team will help guide you through the process of filing an appeal, to get you the benefits you need and deserve. Contact us at (856) 651-1600 for a free case consultation.