Steps to Take When Workers’ Compensation Claim is Denied

Mar 18, 2015 | Claims Process

Most often than not, legitimate workers’ compensation claims are denied. However, this is not the end of the line. A competitive and highly knowledgeable Denver workers’ compensation attorney can help bring your case to the next stage of the fight.

Reasons for Denial

Insurance companies are usually mandated to deny claims for a variety of reasons. When your claim gets denied, you need to know why and you need to know that there is always a thing that can be done after a denial. Some of the most common reasons employers and insurance companies use for denials are:

  • the employee is off-the-work when the injury-causing event occurred,
  • the injury is not sever enough or not disabling,
  • the injury is the result of a pre-existing condition and not aggravated by the work,
  • the employee failed to report the injury within four (4) days, or
  • the employee submitted incomplete medical records.

Next steps after a workers’ compensation claim is denied

As early as possible, acquire the services of a Denver workers’ compensation lawyer. In case your claim was denied prior to having a lawyer by your side, after denial is the best time to get one.

When denied, your next step involves filing an application for hearing and appearing before an administrative law judge. At this stage, both parties to the case will present medical evidence and circumstances in relation to the injury. Specifically, the following will take place:

1. Office of Administrative Courts Hearing

The administrative law judge in this stage will rule whether your claim needs to be appealed or you are entitled to a different kind of benefit. You must apply or request for this before a hearing can take place.

2. Prehearing conference

Before the actual appellate hearing, you will be required to sit with your employer or its insurer to amicably settle the claim. This dispute resolution will be facilitated by the Colorado Division of Workers’ Compensation. No trial will be held during amicable settlements.

3. Petition for Review

Should your claim be denied in the hearing with the administrative law judge, you are required to file an appeal through Petition for Review within 20 days from such decision. After filing, the same judge may modify the decision or may send the case to the Industrial Claim Appeals Panel.

4. Court Appeals

Whichever party will be denied by the Industrial Appeals Panel may further appeal with the Colorado Court of Appeals and the Colorado Supreme Court after that.

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Why you need a Denver workers’ compensation attorney

Claiming workers’ compensation involves a complicated process and is very stressful. A workers’ compensation lawyer can help walk you through the whole process. A Denver workers’ compensation attorney can assist you with:

  • extensively studying the circumstances surrounding your injury,
  • developing a strategy to pursue your claim,
  • filing a claim on your behalf, and
  • recommending to you the best course of the claim.

In case third parties are involved in your case, a Denver workers’ compensation attorney can help you recover from your employer and the other parties.

Kaplan Morell understands your concern and has helped thousands in claiming the compensation due to them. We are the Denver and Greeley workers’ compensation lawyer to contact. Call us at 303-780-7329 for your FREE CONSULTATION.