It’s bad enough being injured while doing your job, but it can be frustrating to be told by your employer’s workers’ compensation insurer that your claim has been denied. You may not have submitted sufficient documentation or kept to the state’s time limits or there may be something simpler that has led to the insurer’s initial decision. You will almost definitely need the help of an experienced workers’ compensation attorney who will help guide you through the appeals process and be present if you are requested to attend a hearing by a judge appointed by the state’s workers’ compensation body. Reasons Why Your Claim May be Denied The simplest reason why a claim has been denied is that there was an administrative error that led to the insurer being given incorrect information, e.g. they may think you were not at work when the injury was supposed to have occurred. The decision may be reversed if the error can be rectified. If the insurer still persists in denying the claim, the next step may be some form of mediation. This is unlikely to involve a judge at this stage. The exact procedure varies somewhat from state to state, so it is important to get advice from your attorney. If mediation fails, an administrative hearing is commonly the next step. This will be a court appearance, or like one, with a judge or even several judges. It will be important to provide all necessary documentation that supports your claim. If the judge still upholds the denial, there are usually further steps that can be taken including an appeal to the state’s Supreme Court or Court of Appeals. alt = "How Long Do I Have to Appeal a Decision By a Judge?"> Time Limits During the WC Appeal Process At each step described above, it is important to be aware of the time limits imposed. These vary from state to state , so you should make sure you know what they are. Failure to keep to any individual time limit, e.g. appealing a decision by an administrative law judge, will mean that your attempt to reverse a decision by the insurer is unsuccessful. An example of time limits is given below for Oklahoma, but bear in mind that these times are state specific and may be quite different elsewhere. • 20 days after mediation before requesting an administrative hearing; • 10 days after a judge’s decision to request a review of his/ her decision; • 20 days after receiving the Commission’s decision to file an appeal with the Oklahoma Supreme Court. Importance of an Attorney Appealing a decision to deny a workers’ comp. claim is a serious and legally complicated business. You can jeopardize your appeal if you try and do it all by yourself. It’s not so much the time limits you have to be aware of, but the amount of preparation you have to organize in between. It’s hard to keep to time limits if progress in between each step of the procedure is painfully slow. The best solution is to get legal help from an experienced workers’ comp. attorney.
