Utah workers may or may not know that they may be able to claim compensation after a workplace injury or illness. Workers’ compensation, when approved by an employer’s insurer covers medical bills and lost earnings. Not all claims are accepted as insurers may deny a claim, even if it seems straightforward to the injured or sick worker. Just because a claim is denied, it is not the end of the story as it is quite possible to appeal an unfair decision. A workers’ compensation attorney can be very helpful providing legal advice and representation where needed. If you have been injured while working in Utah and your claim has been denied, you should speak with a workers' compensation attorney as soon as possible. You have a statute of limitations when filing and appealing your claim, so act quickly. Workers’ Comp. Law in Utah The Utah Labor Commission’s Industrial Accidents Division oversees all matters to do with workers’ compensation, including appeals. Most employers in Utah are required by state law to take out workers’ compensation insurance with a private carrier or self-insure. Only well established large organizations tend to self-insure. Workers’ compensation is paid to compensate for the medical cost of injuries and illnesses that have genuinely occurred in the workplace as well as partial compensation for lost earnings. Injured or sick employees must inform their employers of absence that results from their injuries or sickness within a given time period or risk a claim denial. In fact, it is advisable to inform the employer as soon as possible, even though there is a 180 day limit. It is advisable to provide full information about the accident and subsequent injuries or illness on paper as it can be used as a basis for establishing or supporting a claim later. How a Workers’ Comp. Can be Denied Even if you thought that the accident you had at work was straightforward and didn’t need explaining, you might still find that your employer’s insurer denied the claim or was only prepared to offer a less than satisfactory payment. Insurers can deny claims for several reasons. They may be suspicious that you were not injured at all or that any injuries you declared did not happen at work. Your employer may have made a mistake when they sent information to the insurer and it may seem that there is a discrepancy between the time and date you put on your claim and notice to your employer and the information they gave the employer. Insurers may also claim, or allege, that you were drunk, or deliberately caused the accident to happen. They may allege that you refused to use or wear normal safety clothing, use safety equipment or deliberately ignored safety procedures. They may find that your documentation, particularly medical statements and receipts for expenses does not match the figures and information you put in your claim. Insurers are never happy paying out compensation payments but that doesn’t mean that you cannot challenge their decision successfully even if you have to stick to your guns and persevere. How the Workers’ Comp. Appeals Process Works in Utah A denied claim can be appealed but if this is what you think is the right path to take, don’t expect an easy resolution. You will need to file an application for a hearing with the Adjudication Division of the Labor Commission. The hearing will take several week or even months before it takes place and in the meantime you may opt for mediation. Mediation can resolve a dispute between you and your employer’s insurer without a hearing then necessary. The hearing will be presided over by an administrative judge who will review all the evidence available. The insurer’s representative and their attorney will also be present. The judge will make a decision whether to uphold your claim or accept the insurer’s decision. If you are still unsatisfied with the appeal so far, there are still two further levels available. This is an appeal to the Utah Labor Commission’s Appeals Board which has to be done within 30 days of the administrative judge’s hearing decision as well as a final appeal to the Utah Court of Appeals. The Reasons for Hiring a Worker’s Comp. Attorney An appeal against an unfavorable claim denial may take several months and is a protracted process. It is strongly advised you talk to an experienced workers’ compensation attorney before you submit a request for a hearing. The attorney can review the claim and the evidence you have and advise you of the best way to go forward. Most workers’ comp. attorneys work on contingency and only recover a fee after a successful resolution and subsequent payment so there is no need to worry about upfront legal costs.
