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How to Appeal a Denied Worker’s Compensation Claim

On Behalf of | Sep 20, 2018 | Workers' Compensation

The worker’s compensation system was designed to provide injured worker’s certain benefits to help them heal and get back on their feet after they have been injured at work. Unfortunately, the system doesn’t always work so smoothly. While workers don’t have to prove fault in their employer or the co-workers for their injuries, there are a variety of reasons why their claim might actually be denied. This leaves them footing the occasionally extensive medical bills. However, if the tragedy that is claim denial has come your way after a work injury, it doesn’t mean you need to just accept it. Like many decisions, you have the right to appeal it.

Common Reasons for Denial

Worker’s compensation can be denied for a variety of reasons, but there are a few common ones. While all denials can be appealed, there are some occasions where it is a lost cause. Regardless, common denial reasons include:

  • Your injury was not caused while performing your job.
  • Your injury was the result of a pre-existing condition.
  • There is some dispute as to when, where, or why your injury occurred.
  • A healthcare provider deemed that you were not disabled in any way by the injury.
  • Your work injury occurred when you were under the influence of drugs or alcohol.

How to Appeal a Worker’s Compensation Denial

While claim denial appeal works differently depending on what state you are in, the process is fairly straight forward in Minnesota. Before even filing, you should sort out if you have a case behind you. The first step is to obviously call your insurer and find out why your claim was denied. Sometimes in the best cases you can be denied because you failed to provide the proper documents, which is an easy fix.

However, if the denial was just slightly more complicated, you can start by filing an Employee’s Claim Petition that essentially explains the how and the why a workplace injury happened, what medical treatments your received for it, and what benefits you are seeking. This will be sent to the department of Minnesota Department of Labor & Industry.

Initially, you and your insurer will likely meet with a mediator from the Minnesota Department of Labor to try to work things out outside of court. However, even if the mediator comes to a decision on the state of the claim, both you and your insurer have the right to request a formal hearing to further appeal the claim.

After that happens, you will progress to the court-house for a OAH hearing. OAH hearings are your typical court proceedings. Both sides will present their evidence before a judge, and the OAH judge will make a decision. Even if your appeal fails, you won’t have to pay anything to the insurer, but you won’t get anything either.

What a Worker’s Compensation Lawyer Can Do For You?

While you have every right to represent yourself throughout this whole process, having an experienced worker’s compensation lawyer at your side can be an endless help. Not only are they well-versed in worker’s compensation law, as well as all those little dirty tricks that insurance companies use to not pay out, but they also show worker’s compensation insurers that you are serious. Your insurer will know that with a worker’s compensation lawyer at your side, they won’t be able to convince you that your claim is a lost cause as easily.

If you are filing a worker’s compensation claim or already had one denied, you will want the helping hand of legal representation to guide you. Contact the Law Office of Joshua Borken today if you need the confidence through knowledge that only a skilled attorney can provide so that you can get the benefits you deserve for your work injury.