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The challenges of appealing a denied workers’ compensation claim

On Behalf of | May 30, 2018 | Firm News

If you are a member of the Massachusetts workforce, you may find comfort in knowing that your employer carries workers’ compensation insurance that will cover you if you should suffer a workplace injury. However, are you familiar with the procedures you must follow in the event of a workplace accident? Do you know that the insurers deny many claims?

A serious workplace injury that keeps you off work for some time can cause anxiety and concern for your family’s welfare, and the last thing you need at such a time is a denied workers’ compensation claim. If you thought the claims process was challenging, wait until you have to navigate the appeals procedures.

The appeals process

The first steps to take when you consider filing an appeal include the following:

  • Discover why: Understanding the grounds for denial is critical for presenting a strong appeal. Perhaps, for example, your supporting evidence was insufficient. Maybe you need to submit more thorough medical records or other documentation to support your claim.
  • File the right paperwork: You will have to submit your claim and supporting documentation to the Department of Industrial Accidents. 
  • Meet the deadlines: Strict deadlines apply at all stages of the appeals process. Make sure you file your paperwork within the prescribed timeframe.
  • Attend conciliation: The first step in the appeals process involves an informal meeting with the insurer. (Your employer might also attend.) The goal is to reach an agreement. If you haven’t already, consider hiring a lawyer to represent you at this meeting.
  • Prepare for a conference before an administrative judge: The facilitator at conciliation might refer your claim for conference, which is similar to a trial. This is your biggest opportunity on appeal to turn your case around. It’s therefore not advisable to try and handle it on your own.

As you can see, the appeals process involves multiple steps, complex paperwork and critical deadlines. Enlisting the right attorney can make a big difference in the outcome of your claim.