Workers Comp Claim Denied: Now What?

If your workers comp claim was denied, you probably feel afraid, confused, and even despondent. After all, if you were hurt at work, you deserve to be properly compensated. You might wonder how you are going to pay your medical bills and cope with the loss of income. You might even feel personally betrayed by a company to whom you gave your all. Unfortunately, denials are relatively common. However, continuing to follow through with the process can help you ultimately receive the outcome that you deserve.

What to do when a workers comp claim is denied

Common Reasons for Denial

Although every case is different, workers comp claims are often denied for a few specific reasons:

  • Failure to Report: You should report any workplace illness or injury to your employer as soon as possible.
  • Healthcare Provider’s Failure to Report: Your healthcare provider must assist you in filing a report with the state’s Department of Labor & Industries within one year of your initial injury.
  • Employer Dispute: Your employer has the right to dispute your injury or illness, or to claim that it was not related to your employment. If this happens, you might be asked to submit additional documentation, or you might receive an initial denial.

Your letter of denial will explain the reason your claim was denied, and provide instructions for filing a protest or appeal. Be sure to respond in a timely manner, by the date indicated on the letter. Failing to respond on time can mean losing your right to appeal.

The Appeals Process

Like all states, Washington has a strict appeals process that must be followed. Fortunately, it is a multi-stage process that ensures that your claim receives serious attention from numerous channels.

  • Department of Labor & Industries: The first step is to file a protest with the Department of Labor & Industries (L&I). Write a letter to the claims manager appointed to your case and send it to the address on your letter of denial. Clearly delineate the reasons that you disagree with the decision. A different adjudicator will review your case and issue a decision in approximately 60 days.
  • Board of Industrial Insurance Appeals: If you disagree with the results of your protest with L&I, you can file an appeal with the Board of Industrial Insurance Appeals. Your first step with the Board is a mediation conference. If your case is not resolved to your satisfaction, you have the right to proceed to a full hearing (similar to a court trial) in front of a judge. The judge’s ruling is known as a Proposed Decision and Order.
  • Petition for Review: If you disagree with the Proposed Decision and Order, you may file a Petition for Review. This legal document states the reasons you believe the Proposed Decision and Order is inaccurate, along with supporting evidence. It is reviewed by a three-member board and a decision is reached.
  • State Superior Court Notice of Appeal: The next stage is a formal Notice of Appeal to the state Superior Court. In practice, the Superior Court routinely rules in favor the Board.
  • Higher Courts: Technically, your case could rise to the Washington State Court of Appeals or even the state Supreme Court. However, few workers compensation cases ever reach the highest levels of the state court system.

Hiring an Attorney

Appealing a workers comp decision is a complex process that requires very precise documentation to be filed on very strict deadlines. Unless you are extremely familiar with procedural law, it is generally best to hire an experienced workers compensation attorney to manage your appeal. Your attorney will ensure that all of your paperwork is accurately handled and filed in a timely manner, providing you with the peace of mind you need to focus on healing. Let your attorney fight for you rather than attempting to handle your case alone.

Bryan Stubbs, Attorney at Law, assists clients throughout the Tacoma, WA area. To protect your rights, speak to us as soon as possible after an injury. For over 50 years, our office has been helping injured workers on workers compensation claims and third party claims. We will fight for your rights and secure the best outcome for your injury claim! BBB A+ Rating.

Contact Bryan Stubbs today at 253-383-5891 to schedule a free initial consultation. If you or a loved one have been seriously injured in an accident at work, call us today.

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