Navigating the Appeals Process: What Injured Workers Need to Know After a Denied Claim

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What Injured Workers Need to Know After a Denied Claim

Having a workers compensation claim denied can be an incredibly stressful and challenging situation for an injured employee in Minnesota. You may be facing mounting medical bills, an inability to work, and general uncertainty about your future. Know that you still have options after a denial, including appealing the decision. This blog post provides key information injured workers need to successfully navigate the appeals process in Minnesota.

At Mottaz & Sisk Injury and Work Compensation Lawyers we have years of knowledge and industry experience. Call us at 763-421-8226 today for your free consultation.

Why Are Claims Denied in the First Place?

Before diving into the appeals process itself, it’s important to understand some of the common reasons why workers compensation claims get denied in the first place. Some reasons include:

  • Questions about whether the injury occurred within the scope of employment

  • Disagreements over whether the injury is considered a “personal injury” under the law

  • Uncertainty about whether pre-existing conditions played a role

  • Issues with providing adequate medical evidence linking the injury to the workplace incident

Denials often boil down to insurance companies trying to avoid paying out large claims. However, with an experienced workers comp attorney on your side, many initially denied claims end up being overturned on appeal due to new evidence and arguments.

Making Sense of Your Denial Letter

If your workers comp claim gets denied, the first thing you’ll receive is an official denial letter. These letters can be confusing, even misleading. Some tips on making sense of it:

  • Highlight the exact reason given for the denial. Oftentimes denial letters will have vague, complex legal/medical terminology.

  • Note relevant deadlines. There are strict time limits, usually 30-60 days, to submit your appeal after the denial.

  • Check for references to laws and regulations. These clues can help you (and your workers comp lawyer) craft your appeal strategy.

  • Identify next steps for appealing. Look for instructions on the appeals process, forms to fill out, addresses to submit documents, etc.

Having trouble decoding your denial letter? An experienced workers comp attorney can serve as your translator, making sure you understand why your claim was denied and the basis for appealing.

Grounds for Appealing Your Denied Claim

The good news is Minnesota offers injured employees ample opportunities for appeals after an initial claim denial. Potential grounds for appeals include:

  • Disagreement over the facts: You may argue the insurer or other parties involved have vital facts of the case wrong which impacted the denial. An appeal lets you set the factual record straight.

  • Disputing the medical evidence: There may be disagreement over whether the medical evidence sufficiently proves your injury stems from the workplace incident. You can submit additional medical records, doctor statements, expert opinions, etc. on appeal to clarify this evidence.

  • Questions over legal definitions and standards: Denials commonly hinge on interpretations of phrases like “personal injury,” standards for workplace negligence, etc. Appeals examine whether appropriate legal definitions and standards were applied.

  • Procedural errors: Sometimes insurers deny claims because application forms were filled out improperly or requested evidence wasn’t provided in time. Appeals give you the opportunity to fix these procedural issues.

The key is identifying one or more appealable flaws in the original decision, which an experienced workers comp attorney can help uncover. Keep in mind each case has its own unique set of circumstances an appeal strategy must carefully consider.

Act Quickly: Appealing Within Strict Deadlines

Perhaps one of the most stressful parts about navigating any denial is facing rigid deadlines and time pressure to submit your appeal. Important time windows injured workers must meet include:

Filing the Request for Formal Hearing form: You generally need to file your formal appeal within 30 days of the date when you received your claim denial letter. Otherwise you risk forfeiting your right to appeal.

Scheduling the settlement conference: After filing your hearing request form, the settlement conference date must then be set within 60 days. These conferences provide opportunities to negotiate a settlement and avoid formal litigation.

Finalizing submissions of written arguments and evidence: You’ll need all appeal documents finalized 10 days before the scheduled hearing date. Since it takes substantial time to obtain medical evidence, records, witness statements, etc. after an initial denial, meeting this deadline requires getting a head start well before the conference.

With so many strict cut-offs, delays can sabotage your appeal. Having an attorney experienced specifically in Minnesota workers compensation deadlines on your team prevents missing these vital windows.

Understanding the Different Levels of Appeals

Many workers compensation appeals in Minnesota take months, sometimes years, requiring navigating various stages until (hopefully) your claim gets approved. The levels of appeals include:

Settlement Conference: As mentioned, these negotiations aim to reach an agreement and avoid formal litigation. Over half of appeals get resolved at this initial conference stage.

Formal Hearing: If the conference fails and your claim remains denied, the next stop is a hearing before a workers compensation judge. This hearing involves presenting testimony and evidence to argue why the initial denial was incorrect.

Appeal to Workers’ Compensation Court of Appeals (WCCA): If the dispute continues after the judge’s formal hearing decision, either side can appeal next to the WCCA special court, which reviews whether proper laws and standards were followed.

Appeal to Minnesota Supreme Court: The final appeal option, which less than 1% of claims reach, is bringing the case before the Minnesota Supreme Court. Grounds are generally restricted to resolving ambiguous statutes/rules or addressing broad public policy concerns.

With each stage, the appeals process becomes more complex legally. Relying on a legal professional is key. Otherwise it’s incredibly difficult for injured individuals to continue their fight solo against deny-happy insurers in a system that tends to favor employers.

Finding the Right Lawyer for Your Appeal

Speaking of legal help, having an experienced attorney fighting for your appeal can make all the difference. Benefits include:

  • Taking the burden off injury victims to learn convoluted rules/processes. Your lawyer handles the complex legwork navigating appeals.

  • Bringing proven strategies for building strong arguments tailored to your denial reasons. Their knowledge uncovers appeal angles individuals easily miss.

  • Obtaining medical evidence and testimony essential for appeals to succeed. Lawyers have trusted physician resources.

  • Leveling the playing field against powerful insurance company legal teams aiming to uphold denials. Veteran lawyers know how to counter insurers’ typical arguments and tactics.

So where do you find attorneys with specific knowledge handling Minnesota workers compensation appeals? Here are tips:

  • Search state bar association legal referral services for potential lawyers to interview. Pre-screen them about their injured worker appeals experience.

  • Check lawyer directories and look for attorneys in your area advertising workers compensation experience.

  • Ask trusted contacts like union reps or non-profit workers groups for referrals of lawyers they’ve successfully worked with.

A workers compensation attorney well-versed in appeals gives you the best shot at finally getting your rightfully deserved benefits.


If you made it this far, hopefully you now have a clearer picture of why Minnesota workers compensation claims get denied and how you can appeal those denials. Here we’ll tackle some frequently asked questions for extra clarity:

No. While appealing gives you a strong chance at overturning the decision, some individuals ultimately accept denials if appeals seem too burdensome or success unlikely. Speak to an attorney about evaluating your realistic prospects before deciding.

Retaliation is illegal. While appeals inherently involve some risk should new evidence further justify your denial, experienced lawyers minimize chances of making your situation worse.
You need credible medical evidence linking your injury to workplace conditions. Eyewitness testimony further bolstering this connection also helps. Discuss documentation options with your workers comp attorney.
The short answer is appeals become much harder. But in some cases exceptions occur, such as allowances for extenuating personal circumstances. Experienced attorneys may find argument strategies for recovering your right to appeal.
While rare, some appeals ultimately fail after lengthy court battles if employers have endless legal resources. However, skilled attorneys with proven injured worker track records maximize your chances at success.

Don’t Lose Hope: Why Pursuing Your Rightful Benefits Matters

Going through this denial appeals journey undoubtedly causes frustration and emotional pain on top of your existing injury trauma. Just remember why fighting this uphill battle matters:

Workers compensation exists for protecting those hurt on-the-job who cannot pay crushing medical expenses alone. You deserve care and financial support during treatment and recovery – despite insurance companies often heartlessly denying legitimate claims.

Staying silent means the broken system wins. Continuing your appeals fight, with help from those who champion rights of injured workers, moves us toward greater justice and accountability.

Want professional advice on your denied workers comp claim? Contact an experienced Minnesota workers compensation attorney today and finally get answers and options:

At Mottaz & Sisk Injury and Work Compensation Lawyers we have years of knowledge and industry experience. Call us at 763-421-8226 today for your free consultation.