Appealing a Workers’ Comp Denial​

Sometimes an insurance company can deny a claim. They normally cite that the injury happened on the job, accuse you of fraud about the injury, and even blame you that you had a preexisting condition that caused it. However, if a claim is denied an employee has a right to appeal to the board in their state. For example, in the Florida, injured workers can file with the Division of Administrative Hearings, which assigns the case to a judge who will schedule a hearing within 40 days. 

Contact the Insurance Company After a Denial

After receiving a denial notice from your employer’s insurance company, the first step is to figure out why the claim was denied. If the issue is missing information or paperwork, then this could be resolved. However, clerical errors are not usually the issue.  

File the Appeal

The next step is usually to file a formal claim. There are strict deadlines for an appeal that changes depending on your state. In California, you have a year to file an appeal within a year of refusal. However, Ohio gives only 14 days after a denial notice. Since the proper filing procedures changes per state. It is important to have an experienced workers’ comp denial attorney help ensure your appeal is successful. 

Appeal Hearing

It is wise to have an attorney at these hearings. The hearing board won’t instruct you to have one, but you should. An experienced attorney will know what to expect and how to address and situation in these proceedings. An attorney will present evidence showing why the benefits are needed to the employee. Plus, it helps to include the details of the workplace accident. This shows evidence of where it happened, when and how the accident occurred. We will also ensure that all medical records show the injury. Also, we can also call medical experts to attest to your ability to not work or inability to perform job responsibilities. 

 

The insurance company can also refute the evidence, however the judge will take around 30 days to make a decision. Sometimes, an insurance company may want to mediate to settle a dispute instead going to court. 

Free Worker’s Compensation Consultation

If you hire a knowledgeable complex litigation attorney like those at The Michael Brady Lynch Firm, we work on a contingency fee basis. This means that you don’t pay anything until we win your case.  If your workers’ compensation benefits claim has been denied or you are receiving inadequate benefits, please reach out for a free case review. Our attorneys help clients in a variety of areas, and we tirelessly work to bring them justice and compensation.

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