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  • Graiwer Kaplan Vernik Evans

What To Do If You're Workers' Compensation Claim Is Denied

Facing a denial of your workers' compensation claim can be both frustrating and stressful. However, it's important to remember that a denial is not the end of the road. There are steps you can take to appeal the decision and ensure you receive the benefits you deserve. Here’s a comprehensive guide on what to do if your workers' compensation claim is denied.

The first step is to carefully review the denial letter from the insurance company or your employer. The letter should outline the reasons for the denial. Common reasons for denial include:

  • Insufficient medical evidence linking the injury to your job

  • Failure to report the injury within the required timeframe

  • Discrepancies in your account of the incident

  • Pre-existing conditions

Understanding the specific reason for your denial will help you determine the next steps.

2. Consult with a Workers' Compensation Attorney

Navigating the appeals process can be complex, and having an experienced workers' compensation attorney on your side can make a significant difference. An attorney can:

  • Review your case and the denial letter

  • Help gather additional evidence to support your claim

  • Guide you through the appeals process

  • Represent you at hearings and negotiate on your behalf

3. Gather Additional Evidence

If your claim was denied due to lack of evidence, gather additional documentation to support your case. This can include:

  • Detailed medical records and reports from your healthcare providers

  • Statements from witnesses who saw the accident

  • Photographs of the injury or accident scene

  • Any other relevant documents that can help prove your claim

4. File an Appeal

Each state has a specific process and timeframe for filing an appeal. It’s crucial to adhere to these deadlines to avoid losing your right to appeal. The appeal process typically involves:

  • Submitting a formal appeal letter

  • Providing additional evidence and documentation

  • Attending a hearing where you can present your case

Your attorney will guide you through this process and ensure all necessary paperwork is completed accurately and on time.

5. Prepare for the Appeals Hearing

An appeals hearing is your opportunity to present your case before an administrative law judge or a workers' compensation board. Preparation is key to a successful outcome. Here’s what you should do:

  • Work closely with your attorney to prepare your testimony

  • Organize all evidence and documentation

  • Be ready to answer questions about the incident and your injury

  • Ensure that your witnesses are available and prepared to testify

6. Stay Persistent and Patient

The appeals process can be lengthy and may require several stages of review and hearings. It’s important to stay persistent and patient throughout the process. Keep in close contact with your attorney and follow their guidance to improve your chances of a favorable outcome.

7. Consider Alternative Dispute Resolution

In some cases, it may be beneficial to explore alternative dispute resolution methods such as mediation or settlement conferences. These methods can sometimes lead to a quicker resolution and a mutually agreeable settlement.

A denial of your workers' compensation claim can be a setback, but it doesn’t have to be the end of your pursuit for benefits. By understanding the reasons for denial, seeking legal assistance, gathering additional evidence, and diligently following the appeals process, you can improve your chances of securing the compensation you deserve. Remember, persistence and proper preparation are your best tools in overcoming a denied claim.

If you need legal help with your specific workers' compensation case, schedule a complimentary consultation with one of our experienced attorneys at We're here to help you navigate the complexities of workers' compensation and fight for your rights.

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