How to respond to a denied workers’ comp claim


If your workers’ compensation claim is denied, you are not out of luck. You are still able to appeal the denial, an action that is common in the workers’ compensation process.

To get started, it is important you read over your denial letter carefully. Your denial letter should include the reason why your claim was denied and the deadline for filing your appeal. You need this information to move forward with your claim.

Once you know the reason for your denial, it may be beneficial to meet with your employer or its insurance company to see if the denial was made in error or made because of a misunderstanding. You may also consider working with an attorney who can verify that you did not make any paperwork errors and guide you through the complicated appeals process.

What the appeal process may look like

If you want to appeal your claim’s denial, you will need to file an Application for Adjudication of Claim at the Division of Workers’ Compensation (DWC) office in the county where you live or where you were injured. You will also need to serve the application to the other parties, such as the claims administrator. You will then receive a notice in the mail confirming that your application has been filed.

When you are ready, you can file a Declaration of Readiness to Proceed to request a hearing before a judge. At that hearing, the judge will try to facilitate you and the claims administrator reaching a settlement. If your case is not settled, it will move on to a trial in front of a different judge, who will make a decision on your case. If you disagree with that decision, you can file a Petition for Reconsideration.

Throughout the entire process, it is a good idea for you to keep as many records as you can about your injury, including your time sheet, medical records and related receipts. If you disagree with the evaluation from the doctor covered by your employer’s insurance company, it may be appropriate to have a neutral doctor examine your injuries. If you pursue this option, you should also keep any medical records generated by this examination. Records like these can provide helpful evidence during the appeals process.

Do not give up hope if your workers’ compensation claim is initially denied. If you were injured at work, you still have options to receive the benefits you deserve.

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