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Generally, workplace injuries are taken care of by workers compensation insurance. Several states require employees covered as per the average risk profile attached to the concerned industry. However, if your workers compensation claim is denied, you can take other routes to receive compensation. You can appeal the denial via the board of workers compensation of your state. There are several reasons why a claim could get denied.

Appealing a Workers Compensation Denial

Let’s not focus on the reasons why a claim could have been denied. Instead, we’ll look at how the process of appealing a denial goes forward.

The denial letter must offer a clear deadline to file your appeal, which varies from state to state. For example, in most states, you should file an appeal within in thirty days of having received the letter. Before launching an appeal though, consider meeting with your employer or the employer’s insurance company to find out if the dispute could be easily resolved. There are often cases where disputes were due to a simple misunderstanding or clerical error.

If you are going ahead with the appeal, you should know that the process ahead could be riddled with legal complexities that experienced workers compensation lawyers, such as Ricci Law Firm, would be able to handle better. The appeals process usually entails a hearing in front of a judge, either via the workers compensation board of the state or the labor department. There could be several stages of appeal; check laws of your state for the specifics.

You must bring necessary documentation, including medical records, with you to the hearing. The denial could be due to a second medical exam, a time sheet indicating you weren’t working when the injury happened, etc. If you’re considering appealing, ensure you completely understand your state’s legal procedures.  

Appealing Board Decision

If the board doesn’t accept your claim, you may appeal further to an appellate level court or even the supreme level court.

If an attorney hasn’t been hired or retained at this stage of the process, it’s wise to consult one to tread through the legal process and requisites, which would be required to even put in the appeal successfully.

At this stage, if a decision is issued that isn’t in your favor, you would have most likely exhausted your options. It could take several months or years to get a favorable court decision. The court may push the case to the administrative stage, issuing instructions to the administrative court judge as it sees fit.


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