Can I Appeal Denied Workers’ Compensation Benefits?

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Yes, you can appeal denied workers’ compensation benefits, but it’s likely not in the way you think. After an injury at work, you have rights to file for workers’ compensation claims. While there’s a variety of reasons why a claim may be denied, you have the right to appeal the denial. However, it’s vital to work with an experienced workers’ compensation attorney to understand how to properly appeal the denial and get the money you deserve for your injury. 

Reasons for Denied Workers’ Compensation

When a worker’s compensation insurer denies your claim, the insurer believes there’s evidence the injury you sustained didn’t happen at work or injury isn’t compensable under law. Oftentimes, this is referred to by legal professionals as a primary denial. 


In another instance, a workers’ compensation insurer may deny the extent of your injury. For example, if you’re involved in a slip and fall accident while at work and hurt your shoulder, workers’ compensation will cover the injury sustained from the accident. 

However, if your doctor discovers you have a torn rotator cuff after you’ve received treatment for a little while, the compensation company will send you to an independent medical examiner. If the independent medical examiner believes the torn rotator cuff isn’t from the slip and fall accident or the tear isn’t bad enough to receive surgery, the workers’ compensation insurer will deny the claim.

The Process to Appeal Denied Workers’ Compensation

Primary denials can be appealed with the help of a legal professional, but the process is much more complicated than I believe a lot of people are led to believe. The first part of the appeal is to file a claim petition, which can take up to a year. While this is considered an appeal, it isn’t as simple as writing a letter to the insurance company and asking them to reconsider their decision. There’s a long process that goes into filing a claim petition, which is a lot less confusing to go through when you’re working with an experienced legal professional.

If the workers’ compensation insurer denies covering the injuries you sustained from your workplace accident, your case may go into litigation. Some requests that are commonly filed while a case is in litigation include medical requests and rehabilitation requests.

Common Problems With Appeals

Unfortunately, the workers’ compensation system is complicated. While it’s possible to represent yourself when working with workers’ compensation, it often isn’t the best route to follow. Most people aren’t experts in the laws surrounding the rights and responsibilities of workers’ compensation. 

Sometimes, insurers will stop sending out benefits completely. If you’ve reached out via phone calls and emails, but still haven’t heard back from the company, you likely don’t know what else to do. By working with an experienced workplace injury attorney, you’ll have a team of experts to guide you on your next steps. When a workers’ compensation company stops sending your checks, they’re legally required to send out an intent to discontinue letter. However, if they didn’t, you have 40 days to request a discontinuance conference at the Department of Labor. 

Getting Help to Appeal Denied Workers’ Compensation

Most people aren’t aware of the procedural laws that go into fighting workers’ compensation cases. The way you go about appealing a workers compensation denial will have a huge impact on the success of your appeal. That’s why it’s vital to reach out to a team of experienced legal professionals.

If you have any questions or aren’t sure what to do next to appeal a denied workers’ compensation case, contact Mottaz & Sisk Injury Law today