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Workers’ comp claim denied? Know your options

On Behalf of | Jul 28, 2021 | Workers' Compensation

Suffering a work injury can be upsetting enough without the complications of having a workers’ compensation claim for that injury denied.

However, it is crucial to know that a denied claim is not necessarily the end of your workers’ compensation claim. You can appeal a denial to pursue a better result.

The appeals process at a glance

If you disagree with a denial on your workers’ compensation claim, you can submit an application for an appeal to the Workers’ Compensation Board of Magistrates (WCBM) or you can use the same form to pursue a mediation. This form, which readers can review here, requires employees to enter information about themselves and their injuries. 

After you do this, your case can either head to mediation or trial. Mediation is often suitable for cases where it is likely that parties can reach a fair agreement. An example might be if you disagree with the amount of your lost wages received from an workers’ compensation carrier or you have an outstanding medical bill that the workers’ compensation carrier is refusing to pay.

Cases that go to trial go before a magistrate who will consider testimony, evidence you present and witness statements before reaching an opinion. If you are dissatisfied with the magistrate’s opinion, you may appeal to the Workers Disability Compensation Appeals Commission. Workers’ compensation claims can be further appealed to the Michigan Court of Appeals and then the Michigan Supreme Court but only on issues of law.

This explanation is high-level and does not take into account the myriad of issues that vary between individuals and situations. But in general, applicants should know that there are options for appealing a decision with which you disagree and a process designed to resolve these specific situations.

Avoiding a denied claim in the first place

Of course, having your claim approved initially is preferable to navigating an appeal. And the easiest way to do this is to comply with workers’ compensation requirements and be clear, accurate and comprehensive in completing your claim. Parties can do this by:

  • Reporting the injury right away despite the law providing you 90 days to do so;
  • Seeking medical treatment right away as directed by your employer or workers’ compensation carrier;
  • Asking all medical providers to include the injury history in their notes and asking the doctor to read back their notes to make sure the history is accurate;
  • Following all recommendations made by medical providers; and
  • Providing all doctor’s off work notes or restrictions to both your employer and workers’ compensation carrier.

When you take these steps, you can reduce the risk that the workers’ compensation carrier will deny your claim, making it easier to focus on your recovery and health.

Whether you secure benefits with an initial claim or through an appeal, the important thing is that you know your rights and collect the compensation you deserve.