What Happens If My Work Injury Claim is Denied?
What if my claim was denied?
The main reason claims are denied is because whomever administers your claim believes it is not covered by workers compensation. However, if this is your situation and your claim is denied, you have every right to challenge that decision. There are deadlines to meet in regards to paperwork, and a court hearing will be set when challenging a denial, so be sure to have that in mind. You can contact me or any Workers’ Compensation attorney for additional guidance in this process.
What is the first step?
In order to challenge your denial claim you first need to file a case, which will then be heard and decided by a judge without a jury. To file a case you must complete an Application for Aducaction of Claim, and serve the application on other parties, in this case your employer or whomever denied your Workers’ Compensation claim in the first place. These applications can be filled in an office of the Division of Workers’ Compensation near you. After its filed, you will receive a confirmation letter with your assigned case number, make sure to keep it handy and track all of the documents pertinent to your case with this number.
What happens next?
In order to get a hearing with a judge, or a mandatory settlement conferences (MSC for short) you have to file a Declaration of Readiness to Proceed. At this MSC, the one who denied your claim or their representative and yourself will appear before a judge, discuss the case, and reach a settlement. Sometimes, you may not be in agreement with what the other party is offering, so it is better to know your rights or have an attorney with you who looks out for what benefits you most. The judge in these MSC is primarily there to help both parties reach a settlement they both agree on. If no settlement is reached, the judge will set another date and you will then bring forth other documents, evidence, and witness, once trial commences. A decision is usually reached between 30 to 90 days.
NOTICE: Making a false or fraudulent Workers Compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.