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How To You can appeal a denied workers compensation claim.
There are many legitimate workers' compensation claims denied.You face a complicated appeals process when you have no means to pay your bills.The appeals process is manageable if you pay attention to deadlines, prepare for the trial, and seek affordable legal help.
Step 1: You can read your denial letter.
3 pieces of critical information are included in the letter: why you were denied, a description of the appeals process, and deadlines for bringing an appeal.You have to identify the pieces of information.There are a variety of reasons why workers' compensation claims are denied.You did not report the injury within the required time, it is not severe enough, or it was not sustained on the job.Make sure to pay attention to deadlines.You will usually only be given a month to bring the appeal.You should begin immediately if you want to appeal.
Step 2: You should hire a lawyer.
Bringing an appeal adds to the stress of being denied workers compensation benefits.It can take months to learn confusing rules of evidence in the appeals process.It is possible to streamline the process and bolster your appeal by hiring an experienced workers' compensation lawyer.The lawyer will need copies of your medical information for your appeal if you bring a copy of the denial letter.Pick up any other information your attorney needs.Delays won't affect the appeal process.Private attorneys can work on a contingency basis.If they win your case, they are paid.The attorney will usually take 20% of the benefit amount.State law often caps the amount.You will have to pay for the costs under a contingency arrangement.Filing fees, expert witness fees and money spent on mailing are some of the typical costs.Get an estimate of these costs.
Step 3: To appeal, find the form.
Depending on the state, this goes by various names.It's called an Application for Hearing in Michigan and a Hearing Request form in Arizona.State workers' compensation systems do not cover federal workers.The Federal Employees' Compensation Act has its own methods of determining workers' compensation claims.Federal workers can request a hearing, appeal to the Appeals Board, or apply for reconsideration.Things from the employee are required for each federal appeal.You just request that the hearing representative review the claim.He can either confirm the initial decision or give you benefits.You may not provide new evidence if you are appealing to the Employee's Compensation Appeals Board.You and your attorney can submit new evidence with a Request of Reconsideration.
Step 4: The form should be filed before the deadline.
You should always use certified mail.You will have a receipt for your records.
Step 5: The answer should be read.
Your employer will respond to your appeal.What he will argue on appeal will be revealed by your employer's answer.
Step 6: Don't go for a medical evaluation.
It is possible that you will be required to undergo an independent medical examination.It may be requested by your employer or insurance carrier.The purpose is to identify the cause of the injury as well as the extent of disability.The workers' compensation claims board can request an IME in some states.If you have an attorney, the IME is scheduled according to their agreement with the insurance company.Though you and your lawyer can object to the IME, an objection will often be seen as a concession that the injury isn't as severe as you are saying.All requested medical reports and information should be brought with you.Answer all questions honestly.
Step 7: Prior published decisions should be researched.
Some states have written appellate decisions.Kansas has a database.If your state has a database of decisions, you should check it out.Take a look at other cases similar to yours.If you were denied workers' compensation benefits because of your pre-existing condition, you could research any prior appellate decisions that discussed it.Strong evidence in your favor can be found in a case where an appeal was granted.Your attorney will be able to research prior decisions.You can read the decisions if you ask her for copies.
Step 8: There is relevant evidence to be gathered.
Evidence that supports your claim to have been injured on the job will be needed at the trial.Medical professionals who can testify to your injuries and co-workers who may have seen the injury are the most effective witnesses.It is possible that your state law does not provide for subpoena power.If it does, you can get a blank subpoena form from the workers' compensation board.A witness can be assured of their attendance by serving a subpoena.The form needs to be filled in with the witness's name and address.The date and time of the hearing, as well as where the witness is commanded to appear, should be filled in.Mail the subpoena with certified mail.Give the witness plenty of time to rearrange her schedule so she can attend.
Step 9: Prepare to testify.
You will be called to testify about the injury, how it happened and the extent of your disability.Ask your attorney to do a practice run to make sure you are an effective witness.Your attorney should ask hard questions to help you understand the process.You should review your summary of the event.You should have written down what happened after you were injured.To refresh your memory, review this information.Stay hydrated on the stand.An attorney may try to frighten you.You have nothing to hide.
Step 10: Attend a hearing.
The first appeal can be heard by an administrative law judge or a state appeals board.You may be called in for a pre- trial hearing.The purpose of the hearing is to prepare the parties for trial.You should ask any questions at that time.If the other side has turned over copies of their witness list or medical reports, you should ask.
Step 11: Arrive on time.
You don't want to be late.If you don't know where the trial is being held, give yourself an extra hour to find parking and go through any security.Courts rarely hold trials.The offices of the workers' compensation board are where they are usually held.Dress nicely.It's comfortable to look professional.If you feel awkward, you don't have to wear a suit.
Step 12: Give an opening statement.
In a trial before a jury, the opening statement will be more formal.The attorneys will tell the judge what issues the parties have agreed on and what is in dispute, such as whether or not you were injured on the job.
Step 13: Give it a go.
You will be called to testify by your attorney.Your lawyer will ask you questions after you swear an oath.Speak loudly to the judge.You should have practiced with your lawyer.She can't ask you questions that contain the answer.She can ask more general questions such as, "Where were you on the morning of...?" and "Did you hurt yourself?"You should have a good idea of what questions the other side will ask if you read your employer's answer.If your employer claims you were injured while on vacation, you should be prepared with detailed questions about where you went and what you did.
Step 14: Give a closing argument.
Your lawyer should brief you on how the evidence supports your legal right.He will respond to your employer's arguments.
Step 15: Wait the decision.
A written decision is typically drafted by the appeals board.You can receive it by mail.Sometimes an appeals board will either review the written order or send it back for a second look.
Step 16: Discuss the next steps with your lawyer.
An appeal of the denial is possible if your claim is denied.Discuss if another appeal is worthwhile and if your attorney will handle it.On contingency, appeals can be handled.The scope of the representation may be redefined by a new client agreement.
- You can apply for workers compensation.
- How To Question witnesses when representing yourself.
- How To Appeal a Summary Judgment
- You can find a civil rights attorney.