Learning you have been denied workers’ compensation can be devastating after a work-related injury. However, you can appeal your denial and fight to receive your benefits.
The appeals process is generally outlined in your denial letter. Carefully review the letter and learn the specific reason for the denial.
Sometimes an appeal is not necessary. If your workers’ compensation claim was denied because of incorrect or incomplete information, providing the necessary information or documentation can result in benefit approval.
File by the appeal deadline and gather your evidence
In situations where an appeal is required, take note of the appeal deadline in your denial letter. File your appeal by the deadline, even if you do not have your evidence ready yet.
Getting your appeal filed on time is important. Missing the appeal deadline could cost you your opportunity to appeal. Once you file the appeal, you can focus on preparing for your appeal hearing.
Gather all documentation related to your claim. Evidence can include medical records, witness statements and written correspondence with your employer and their insurance company. Any accident reports from the incident are also important evidence.
What happens at the appeal hearing
A workers’ compensation hearing is usually held in front of an administrative law judge (“ALJ”). The ALJ will allow each side to present testimony and evidence, ask any questions they have, review the evidence and issue a decision.
You will likely need to testify about the injury, the medical treatment you received and the effect the injury has had on you. Be prepared to provide detailed testimony about the injury, such as where and when it occurred and what exactly happened.
Your employer or their attorney may ask you questions during cross-examination. This is to cast doubt on your testimony or provide a different version of what happened.
Practice your testimony before the hearing. This helps you stay calm and collected during the hearing and helps you learn any areas your testimony may be weak or inconsistent.
Next steps after the hearing
The ALJ will not decide your case on that same day. You will receive a written decision in the days or weeks after the hearing that details the reasoning behind the decision. If you disagree with the ALJ’s decision, you can appeal to a higher court.