The process of appealing a denied workers’ comp claim

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The process of appealing a denied workers’ comp claim

Workers’ compensation and the protections it provides for injured workers and their families are important. For that reason, it can be alarming when an injured worker is denied vital workers’ compensation benefits. Because of the important of workers’ compensation benefits, there is a process to appeal a denial of workers’ compensation benefits that injured workers should be familiar with.

Administrative review

Injured workers can file an appeal of a workers’ compensation denial and request an administrative review of a judge’s decision. Without an appeal being filed, the judge’s determination is considered a final decision. An appeal must be filed within 30 days from when the judge files their decision. Injured workers can file an appeal regarding the payment of their medical bills by the insurer to their medical care provider.

Forms for filing an appeal

There are certain forms the injured worker should expect to provide as part of their workers’ compensation appeal. Some of the information the injured worker should expect to provide as part of their appeal includes whether or not their accident was work related; the relationship of employee and employer; their insurance coverage; their average weekly wage; reduced earnings information; death benefits; degree and period of disability; the approval of medical treatment and payment of medical bills; and several other considerations as well as any other issue that was part of the underlying decision.

Reasons for the appeal

In addition, the injured worker will need to provide the grounds for their appeal of the decision. They should be prepared to specify what part of the denial decision is being contested; the requested outcome of the appeal; and the reasons why the requested outcome should be granted.

Workers’ compensation benefits are important to injured workers and their families to help them get through a difficult time. For that reason, injured workers should be familiar with the process of appealing a denied claim for benefits and also bear in mind that because an appeal can be complex, trained guidance through the process can be helpful.