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Can I appeal a workers’ compensation denial?

On Behalf of | Jan 6, 2023 | Workers’ Compensation

Being injured on the job can cause you many problems. As you struggle to recover from your injury and cannot work, you depend on workers’ compensation benefits to help you pay your bills and stay financially afloat.

Therefore, it may come as a devastating shock to learn that your workers’ compensation claim was denied. You will typically find out if your claim was denied by receiving a letter after filing a workers’ compensation claim with the Kentucky Department of Workers’ Compensation.

Review your denial letter carefully

Your notice should state the reason for the claim denial. If it doesn’t, you should contact your workers’ compensation insurance company to find out the reason.

In some cases, the denial could simply be due to lack of information. The insurance company might need you to submit some additional information or documentation before approving your claim.

Yes, you can appeal

If the denial is for another reason that you do not agree with, you can appeal. Your denial letter will describe how to appeal and any deadlines. Make sure to appeal within the deadline, or your appeal can be denied.

Before being scheduled for a workers’ compensation hearing, you will have a benefit review conference. This is a meeting between you, a third-party and your employer’s insurance company to see if you can resolve the issue.

Bring any documents you think may help you to the conference, such as your medical records, or anything else you believe can help you prove your case.

Ideally, you can reach an agreement at the benefit conference, but if you cannot, you will then be scheduled for an appeal hearing before an Administrative Law Judge (ALJ).

Your appeal hearing

At your appeal hearing, you can testify and present witnesses and other evidence to prove your claim. Your employer will do the same.

The ALJ does not decide your claim right away but will issue a written decision sometime after the hearing.

Waiting for your workers’ compensation benefits after a denial can cause you extreme anxiety. An employment attorney can help you learn what to expect and potentially represent you at an appeal hearing.