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What options do I have if my workers’ comp claim was denied?

On Behalf of | Nov 22, 2021 | Workers' Compensation

After a work accident, getting workers’ compensation can be crucial for an injured party and their family. This money provides critical support that helps people get medical care and cover a portion of lost wages a person experiences because of their injury or illness.

As such, learning that insurance denied your claim for benefits could be incredibly upsetting. However, there are things you can do to address this and still pursue financial remedies.

Determine the reason behind the denial

To assess your next steps, you will want to determine the reason for the denial. There are several common reasons why insurers or employers might deny workers’ compensation benefits. These reasons include:

  • Deciding an accident was not job-related
  • Finding the injured party is not eligible for coverage
  • Claiming the injury was pre-existing
  • Finding the person was intoxicated or impaired at the time of an incident
  • Lacking proof of the work-related injury

When you know the reason for the denial, you can better understand the next steps. You may need to challenge the decision, request a review or present new evidence through an appeal.

File an appeal

If you dispute a workers’ compensation decision by the workers’ compensation insurance carrier, you can appeal it. In Michigan, there are four levels of appeal.

You will start by filling out an application for a hearing or mediation and submitting it. After that, a Magistrate for the Workers’ Disability Compensation Board of Magistrates will review your case and decide based on transcripts of depositions taken of your doctor(s) and a vocational expert prior to the hearing.

If this ruling is not satisfactory, the next step is to file an appeal with the Workers’ Disability Compensation Appeals Commission.

If you still are not satisfied with the decision, you can then appeal to the Michigan Court of Appeals and then finally the Michigan Supreme Court.

The procedural requirements for appeals become increasingly complicated as you move to the next level and having legal representation throughout the process is crucial to the outcome of your case.

From the day of your injury, you must be sure to notify your employer.  You must report a work-related injury within 90 days, and you only have two years from your last day of work to file a workers’ compensation claim.

If you appeal a decision, the time to file can range from just 15 days to 30 days after the mailing date of the decision. 

Understanding this process and acting quickly can improve the likelihood of getting the financial benefits you need and deserve.