What Can You Do If Your Workers’ Compensation Claim Was Denied?
Legally Reviewed and Edited by: Terry Cochran
Being injured on the job can cause significant issues, both physically and financially. Usually, your employer’s workers’ compensation insurance coverage will provide benefits, covering your costs until you can get back to work. But what happens when your workers’ comp claim is denied?
Most employers in Michigan must have workers’ compensation insurance to cover their injured workers. However, many claims receive denials the first time around. This is where a specialized workers’ compensation attorney can help by reviewing your claim and helping you appeal the decision.
Determine Why Your Workers’ Compensation Claim Was Denied
Insurance companies and employees will look closely at your claim to determine if there is any reason to deny it. However, any reason they provide must be legally valid. These reasons include:
- Timing Issues: To receive workers’ compensation benefits, you must report any injury or illness to the employer right away. In Michigan, you must give notice, written or oral, of a work-related injury or illness to your employer within 90 days of its occurrence. You then have two years to file the workers’ compensation claim. If you miss either of these deadlines, your claim may be denied.
- Dispute Over Whether it’s a Workplace Injury: Employers may state that the injury is not work-related, often by claiming you were not at work when the injury occurred, your injury occurred due to misconduct, or your medical condition didn’t result from a workplace incident.
Your employer’s insurance company may cite other potentially disqualifying reasons, including the fact you did not seek medical attention, or that you suffered from pre-existing conditions.
Appeal Your Workers’ Compensation Claim Denial
The next step after determining why your claim is denied is to file an appeal of the decision. The denial letter provides information on how to file this appeal and also a deadline to do so. For your appeal to be successful, you must follow the instructions on your denial letter precisely. Missing a deadline or failing to submit necessary documents may cost you significant time.
Following a denial in Michigan, you can file an application for mediation or hearing with the Michigan Workers’ Compensation Agency. The agency reviews your application and may schedule a mediation first or move straight to a hearing.
Mediation is often granted under the following circumstances:
- You are requesting medical treatment reimbursement only
- Your claim is for a specific time period, and your return to work has already occurred
- You are representing yourself, with no hired attorney
- The workers’ compensation agency believes that mediation will be helpful to your case.
The mediation aims to reach a voluntary settlement between you and your employer and their insurance company.
If mediation is unsuccessful, or you are ineligible for mediation, the next phase is a hearing before a magistrate or administrative law judge. This hearing is to review your case, address any preliminary issues, and schedule a trial date.
The non-jury trial is an opportunity for you and your employer’s insurance carrier to present evidence for or against the claim, including medical records. Either side can bring in witnesses, including medical professionals and eyewitnesses to the accident that caused the injury. An attorney can help you find expert witnesses to support your injury claims.
While you can take this next step on your own, having an experienced workers’ compensation or personal injury attorney in your corner can be beneficial. Your legal representation can ensure you meet all deadlines and submit your required documents, help prepare and present witnesses, and argue for you during the hearing.
Filing Further Appeals
If you receive another denial after your hearing, you can file further appeals. You must first make an appeal to the Michigan Compensation Appellate Commission, which will make a decision based on previous documents, including the trial transcript, recorded statements, final decision, and written arguments by both sides.
If you still disagree with the decision, you may continue with an appeal to the Michigan court system. For this, an experienced workers’ compensation attorney familiar with the process and court procedural rules is essential to give you the best possible opportunity for a successful outcome.
While you may receive a favorable decision at the hearing level, your employer or their insurance company may continue to challenge the claim. To determine if you will receive benefits during this period, consult with your attorney familiar with the workers’ compensation system and claim process to see if you are eligible.
Work with a Professional Workers’ Compensation Attorney in Michigan
When you experience an injury on the job, and your workers’ compensation claim is denied, it’s time to seek the professional legal help with Cochran, Kroll & Associates, P.C. Our dedicated workers’ comp attorneys will review your case and file the appeals on your behalf. Call our law office today at 1-888-MICH LAW (1-888-642-4529) to schedule a free initial consultation.
Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.