How to Appeal a Denial of Benefits

October 9, 2019

Thousands of employees across the United States suffer from work-related illnesses or injuries. Such illnesses lead to loss of wages, high medical bills, pain, and suffering. This can be a significant financial burden for employees. In instances when an employee is denied benefits, it can further ruin their financial situation. However, it is possible to appeal a denial of benefits successfully.

Reasons You May Receive a Denial

Insurance companies can deny benefits for many reasons, like if you were injured outside of work, or were under the influence of drugs or alcohol when the injury took place. Check out the video below for more information:

To avoid receiving a denial of benefits, it’s paramount that you notify your employer of an illness or injury as soon as possible. If your claim is denied, you have up to two years to file an appeal. When the time comes to file an appeal, you must contact a legal professional.

How to File an Appeal

Before filing an appeal, you should first try to understand why you have been denied benefits. In most cases, claims are rejected because of clerical errors. This can work in your favor, as it allows yourself and the insurance company to work things out before a formal appeals process takes place. 

If you fail to reach an agreement with your insurance company, you must file a Petition to Determine Compensation Due to the Office of Workers’ Compensation. Inside the petition, you should explain the dispute and why you think you should have a hearing. We recommend that you request a return receipt with these documents.

Once the petition has been filed, you should receive a document with the time and date of the pre-trial. At this point, a pre-trial memorandum needs to be registered with the Office of Workers’ Compensation. This memorandum will contain all the essential information relevant to the case. This includes doctor’s reports, identifying witnesses, and a statement outlining what benefits you are seeking.

A hearing will occur before the Industrial Affairs Board. After both parties present their case, a decision will be given fourteen days after the hearing.

If either party is unhappy with the result of the hearing, a request for appeal can be filed within 30 days of the decision.For more information, please contact us today.