What Happens if a Claim is Denied?

There are several reasons a legitimate claim could be denied or limited. The most common reason is that injured workers fail to meet the state deadlines for filing or forms aren’t correctly completed.

Other reasons a claim could be denied include:

• Missing forms or documentation
• Lack of credible evidence (i.e. medical records, witness testimony, etc.)
• Disputes with the employer or insurance company
• The injury isn’t severe enough to qualify

If you receive a letter from the Commission denying the claim, note the appeal deadline, and contact a workers’ compensation law firm immediately.

To appeal a denied decision, promptly notify the relevant commission within 14 days. Engage in a mediation conference with your workers' compensation lawyer, where a mediator will provide a recommendation based on the claim evidence. 

The appeal process involves a hearing with a judge, requiring meticulous organization and evidence gathering. Success hinges on presenting comprehensive medical records, bills, and evidence. An experienced workers' compensation attorney is crucial due to the complexity of the process.