For most of us, it is disappointing to be informed that our workers’ compensation claim has been denied. It is not unusual for the employer or the employer’s insurance service providers to dig up causes for rejecting that the victim was really an employee, or the injury took place at work. However, if you believe that your compensation benefits have been turned down incorrectly by your claims administrator or the insurance service provider, you have the right to challenge the denial. You can file an appeal at one of the division’s 24 offices and a workers’ compensation administrative law judge would hear your case.
But to begin with you should know why the claim was denied. This is the primary thing that every employee requires to understand. There can be many reasons for it. It could be denied for merely not matching the eligibility norms, for example getting injured while away from work. It can also be for lots of other reasons such as the accident not reported in time, claim not filed within stipulated time, no medical treatment received for the injury and lack of sufficient evidence that the injury occurred at work.
If you have been denied compensation claims and want to contest the decision, you must first file an application for adjudication of the claim at one of the Division of Workers’ Compensation’s office. The DWC office is a trial court and compensation claims are heard by a judge. While filing the application, you must ensure that either your state of residence or the state where the injury happened comes within the jurisdiction of DWC. The application must be served on all other parties including the claims administrator.
After filing the application, you will receive a confirmation notification from the DWC office along with your assigned case number. The case number must be mentioned on all documents and future communications with DWC in connection to our case. Then, in order to request a hearing, you will have to file a Declaration of Readiness to Proceed and subsequently your case will be scheduled for a mandatory settlement conference.
The judge will discuss the case with you and the claims administrator and try to support in attaining a settlement. In case of the failure to reach a settlement, the judge will then list the case for trial. During the trial the case will be heard by another judge. After the trial, you will be issued a written verdict through mail; it takes one to three months to receive the verdict. In case of disagreement with the decision by you or the claims administrator, there is the option to file a Petition for Reconsideration.