What Happens If Your Workers’ Compensation Claim Is Denied?

There are up to five steps in the legal process if your workers’ compensation claim is denied. You should consider hiring a workers’ compensation lawyer at this point, as it can be difficult and time consuming to go through this process on your own. Your chances of successfully appealing a denied claim are greatly increased if you have a lawyer to represent you.

1. Filing a claim: Your lawyer needs to file paperwork with the Department of Industrial Accidents (DIA) in Massachusetts. Your lawyer will gather up evidence for your claim and send it in to the office with a claim form. Once this is done, you will be able to move on to the conciliation stage of the dispute process.
2. Conciliation Session: Conciliation is when two opposing sides are brought together to negotiate and reach a compromise in an attempt to avoid a hearing. In workers’ compensation cases, either you or your lawyer will file a claim for benefits. If the insurer files a complaint to stop or change your benefits, a conciliation session may be scheduled. An informal meeting between you, your attorney, the insurer, and a conciliator from the DIA will then take place.
   At the conciliation, there will be an attempt to reach a voluntary agreement between you and the insurer. If a voluntary agreement cannot be obtained, your claim’s status will remain the same. You will need to bring your most recent medical documentation with you to the meeting as evidence. It is important to consider hiring a lawyer for this procedure.
3. Conference: If your case is then sent to an Administrative Law Judge after conciliation, a conference will be scheduled. This is another informal meeting between the parties. If the claim is not settled at the conference, the Judge will issue a temporary order stating whether or not the insurer must pay you. If you do not agree with the judge’s order, you have 14 days to appeal the decision. The insurance company will also have the right to file an appeal.
4. Hearing: If your case does get appealed by either you or the insurer, it will move to the hearing stage where the judge will hold a formal hearing and examine all the evidence. After determining the case at the hearing, each side will have the right to appeal the decision again within 30 days.
5. Review Board: Three judges will examine what happened at the hearing and in some cases may ask for legal arguments to be made. They will only reverse the decision made at the hearing if the decision was beyond that Judge’s authority, went against the law, or was not justified.

Why Call Us?

If your workers’ compensation claim is being disputed, you should consider hiring a lawyer to help represent you. The experienced workers’ compensation lawyers that we work with charge no fee unless they win your claim or you get a settlement. For a free (no obligation) case evaluation, call our toll free number or fill out a contact form online.