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How to Appeal a Denial for Workers’ Compensation

Workers' compensation claim form

Workers’ compensation is the insurance coverage that most employers must purchase to provide compensation for injured employees throughout the duration of their employment. Workers’ compensation exists to protect businesses from being sued due to the built in payment plans that many employees sign for. This is not to say that workplace lawsuits do not happen even with workplace compensation, but it is more rare. The problems arise when employers provide workers’ compensation but fail to approve claims made through this program. If your workers’ compensation claim is ever denied there are a few steps you can take to get your claim successfully appealed.

Contact your insurance company. If your claim is not approved, make sure it is not because of a clerical error or typo. Sometimes claims are denied because of missing documents or simply typographical errors that make the claim look fraudulent. If you want to make sure you are not denied for this reason, make the call to find out. The solution to a denial of this sort is usually to refile the claim correctly.

Ask for reconsideration. Denials may be reversed if new information is presented that changes the situation regarding the claim. While resubmitting the file with the same information will not yield different results, sometimes the solution is as simple as including more personal information or facts about how the injury is impacting you.

Get the appeal paperwork. The worker’s compensation appeals process may have required forms for the state, so you will need to pick up the right application to get a denial appeal or adjudication. Depending on what caused the injury you may need a different form, and the deadlines can vary and pass quickly. To ensure you do not miss out on a claim because of this, check the dates and set up a schedule to turn in your appeal well in advance.

Gather evidence. Workers’ compensation appeals are similar to trial in that you must have evidence to support your claim of injury and subsequent benefits. This may include providing a medical history and doctors notes regarding the severity of the injury, documentation after the incident occurred, paperwork that was filed on your behalf, or any transcriptions of conversations made regarding the original claim.

Contact an attorney. An appeal to a workers’ compensation claim can be messy and filing it wrong could lead to a lack of deserved benefits. If you contact our attorney’s office, you can speak to a compensation personal injury attorney who can represent you in the appeal hearing and proofread and file any paperwork necessary. The investigative teams would be happy to provide evidence to support your claim, so call us today so Colley Law can provide you with the compensation you deserve.