There are many different reasons for a workers' compensation claim being denied, such as:
- The claim was not filed on time
- The injury was not reported on time
- The filer didn't receive medical treatment after suffering their injury
- Lack of evidence to show that the injury is work-related
- The injury is not compensable
- An employer disputes the claim for benefits
When a workers' comp claim is denied, there are other options that workers can use to appeal the decision and possibly receive benefits. Below, we explain what to do when a workers' compensation claim is denied.
The Appeal Process
After a workers' comp claim is denied, the claimant will receive a letter that details the specific reasons for the denial. After receiving this letter, the worker should contact their employer or their employer's workers' compensation insurer to discuss the claim in greater detail. If the claim was denied because improper paperwork was filed, there is the possibility that the error might be able to be resolved and the claim will be approved. Unfortunately, this is unlikely, unless the mistake was made on the part of the employer or their insurance company.
Workers can also request a hearing to appear in front of a local Workers' Compensation Appeals Board judge. At this hearing, they can file an Application for Adjudication of Claim. After the hearing, the worker will have to file a form called a Declaration of Readiness to Proceed (DOR).
Priority Conference
If the insurer denies the claim because they believe the worker's injury "arose out of employment" (AOE) or that the injury did not happen during the "course of their employment" (COE), the judge will schedule an expedited conference to resolve the dispute and determine if the worker's claim can be accepted or denied. It is important to note that workers need to check the boxes "Priority Conference" and "AOE/COE" on their appeal form to get a priority conference.
Do you have more questions about appealing a denied workers' comp claim? Contact our Columbia team of workers' compensation attorneys to discuss your case today.