In some cases, getting compensated in the aftermath of an injury might not be as easy as you initially anticipated. In the vast majority of circumstances, workplace injuries are covered by employers with worker’s compensation insurance.
This doesn’t mean your claim will be accepted. If your case is denied, there are still some options and you have the power to appeal to the denial and try to reverse the outcome of the situation. Appeals happen through the state’s board of workers compensation—but before trying that route, it is important to understand why your particular case has been denied. To cover every possible scenario and to gain a better perspective of the situation, as well as your own rights, it might be wise to hire an attorney to consult and assist you through the process.
Specific regulations will vary from state to state, but there are many reasons why your worker’s comp claim could have been denied.
Potential reasons for a denied Workers Comp claim
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.
Official 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.
Talk to Kaplan Morrell today, a trusted Workers Comp lawyer
Workers Compensation can be difficult, confusing, and very complex. The laws also change every year. Kaplan Morrell has helped thousands of injured workers since 1997 get the benefits they deserve.
Contact us here or call us at 303-780-7329 for your free consultation.
