Call Us!What To Do When Your Workers’ Comp Claim Is Denied
Workers’ compensation began as a benefits program for some federal employees in 1908. In less than a decade, the program expanded to cover all federal employees, and states began enacting workers’ compensation laws. In 2023, 2.6 million employees working for private industries filed workers’ compensation claims. That number rises to approximately 4.9 million when government employees are included.
Workers’ compensation ensures employees receive income when they are recovering from work-related illnesses or injuries. The Federal Reserve reports that 46% of Americans lack the savings needed to cover 90 days of expenses. Without workers’ compensation, many employees would face extreme financial hardship if they missed work due to workplace injuries or illnesses.
Although workers’ compensation is a crucial benefit people rely on to cover their bills if they’re coping with work-related illness or injuries, almost 7% of claims are denied each year. If you’re dealing with a denied workers’ comp claim, you can file an appeal. A workers’ compensation lawyer can explain the process and help you file.
Or suppose you’re preparing to file a workers’ comp claim. In that case, referring to these effective workers’ compensation tips and hiring a workers’ comp lawyer can help you prepare a compelling claim and avoid having your claim denied.
Common Reasons Workers’ Comp Claims Are Denied
You must have an injury that meets the statutory definition of an injury under workers’ compensation to file a claim that workers’ compensation will approve. This means you must have incurred one of the following:
- An illness caused by workplace or work-related conditions.
- An injury from an accident.
- An injury resulting from a deliberate act related to your employment.
Workers’ compensation will deny your claim if the reason for your claim does not meet the statutory definition.
Another reason workers’ compensation claims are denied stems from who’s involved in a workers’ comp claim. Your employer must file documentation in support of your claim. If your employer does not file the appropriate paperwork in time or disputes that you suffered a work-related illness or injury, your claim will be denied.
Other reasons workers’ compensation claims are commonly denied include the following:
- A lack of medical evidence of injury.
- A lack of witnesses to verify the claim.
- The claimant has a history of multiple filings.
- The claimant misrepresented facts related to their claim.
- The claim relates to a pre-existing condition.
- The claim was filed late.
- The cause of the condition is unknown (and therefore not verified as being work-related).
- The employee was intoxicated or using drugs when injured.
- The injured party isn’t an employee.
Steps To Take Immediately After a Denial
You will receive a formal notification if your workers’ compensation claim is denied. This notification will identify the reasons for the denial.
The most effective steps you can take if you receive a denial after filing a workers’ compensation claim are to gather evidence that refutes the reason for the denial and consult a workers’ compensation attorney.
Workers’ compensation attorneys have extensive knowledge about workers’ compensation law and the legal standards for justifying a claim. They can gather evidence and prepare an appeal to help you get the compensation you deserve.
How To Appeal a Denied Claim in Colorado
Information on how to file a “Petition to Review” will be included in your claim denial. You must follow the instructions or hire an attorney to help you navigate the process.
Once you or your attorney files the Petition to Review, you must request a transcript of the denial hearing.
Your next step is to prepare a written statement supporting your appeal. Your written statement is the key evidence used to decide your appeal, so you must provide substantiated information that justifies your claim. A workers’ comp lawyer will prepare a compelling statement that highlights the evidence available to support your claim.
Timeline and Deadlines for Appealing
Colorado gives employees 20 days to file an appeal after receiving notice that their workers’ compensation claim has been denied. After that, you have 20 days to prepare a written statement that supports your appeal petition.
The opposing party can counter your response. Once your response is filed, they have 20 days to file theirs.
Once your petition, your written statement, and the opposing party’s response are filed, the appeal is handed over to an administrative law judge. Ideally, the judge will issue a favorable decision within 30 days. However, if the judge does not approve or deny your appeal within one month, the Industrial Claim Appeals Panel reviews the appeal. The Industrial Claim Appeals Panel has 60 days to render a decision.
In total, it takes between three and four months to resolve your Petition to Appeal.
The Colorado Court of Appeals can review a subsequent appeal if you do not receive approval for your claim. You have 21 days to file another appeal once your Petition to Review is denied.
How Important Is Legal Representation in the Appeals Process?
When dealing with a denied claim, it is crucial that you consult an experienced workers’ compensation lawyer. Workers’ compensation attorneys have extensive legal knowledge and familiarity with the appeals process. You won’t have to worry about learning how to prepare filing documents, figuring out what evidence can refute the reason for the denial, or writing a compelling statement. Your attorney will provide expert legal counsel and help you navigate the appeals process while working on your behalf to gather the information needed to support your appeal.
The Petition to Review process provides a limited amount of time to complete each step of the process, which is another reason you should hire an experienced workers’ comp attorney if your claim is denied. Your attorney will ensure you present the strongest possible case while meeting the deadlines.
How Bachus & Schanker Can Help With Denied Claims
Bachus & Schanker understand that dealing with a workplace illness or injury is traumatic, and the fear of financial issues can interfere with your recovery. Without workers’ compensation benefits, you may feel compelled to return to work before you should, which could compromise your health.
Bachus & Schanker will fight for you to receive workers’ compensation. We will investigate your illness or injury, gather evidence that supports your claim, and prepare the Petition to Review, and a written statement that the Industrial Claim Appeals Panel will find compelling, giving you the best chance of a ruling in your favor.
Our legal team is here to help. We will answer your questions and explain the steps we can take to help you get workers’ compensation benefits.
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