Workers’ Compensation Denied? Here Are Steps To File an Appeal
If the insurance company denied your workers’ compensation claim, you can appeal for the benefits you deserve. A Lafayette workers’ compensation lawyer can lead the appeals process for you, including filing the paperwork and accompanying you to any necessary hearings.
While you should be aware of the steps in the appeals process, know that your lawyer will take the lead for you. Your attorney and their paralegals will create and manage your appeal, so you can focus on your health.
What to Expect From the Workers’ Compensation Appeals Process
When a workers’ compensation insurance provider denies your claim, your fight for compensation begins. An attorney can guide you through the appeals process, which generally involves the following steps:
Filing the Appeal
Your attorney will file an appeal with the Louisiana Office of Workers’ Compensation (LWC). Form 1008, also called a Disputed Claim for Compensation, requires you to explain:
- Your name and employment information
- Your employer’s name and information
- The date and time you were injured
- The details of your workplace injury
- Details of your medical care
Your attorney will help you complete this form, ensuring its accuracy, completion, and proper filing.
Mediation
If an insurance company and an injured worker disagree, a disputed workers’ compensation claim may enter mediation. During this process, a third party can help the claimant and insurance company negotiate a financial resolution. Though mediation does not happen in all workers’ compensation appeals, your lawyer may discuss this option with you.
Pre-Hearing Proceedings
Depending on how the insurance company responds to your appeal, the pre-hearing process may include:
- A preliminary determination hearing, which the insurance company may request to achieve a decision without a formal appeal hearing (you can challenge an adverse ruling, in which case your appeal will proceed to a hearing)
- Discovery, at which time both parties will exchange information about the case
- The filing of any pre-trial motions and pleadings
- Any negotiations the claimant and insurance company choose to engage in
If the pre-hearing process concludes without a resolution, your attorney will prepare for a hearing.
Appeal Hearing
Your lawyer will issue a pre-trial statement to the judge overseeing your workers’ compensation appeal hearing. This statement will outline the broad strokes of your case.
There may be a significant time gap between when you file your appeal and the beginning of your hearing. Your attorney will use this time to prepare for the hearing. During your hearing, your lawyer will:
- Present and question experts and witnesses whose testimony could benefit your appeal
- Present testimony they have previously obtained through depositions
- Question any witnesses the insurance company presents
- Present evidence and arguments related to your accident
- Present documentation of your medical expenses, lost wages, and other losses
- Submit a post-hearing memorandum, if necessary
You will generally receive a judge’s decision about your appeal within 45 days of your hearing’s conclusion.
This is only the big-picture summary of the workers’ compensation appeals process. The entire workers’ comp process can be supremely complex. Various deadlines, rules, and procedures may be overwhelming to those who are unfamiliar—including injured and sick workers.
Allow a workers’ compensation lawyer from our team to fight for the workers’ comp benefits you are entitled to.
Why an Insurer May Deny Your Workers’ Compensation Claim
To appeal a claim denial effectively, we must know why a workers’ compensation insurance provider denied your claim. An insurance company may deny a workers’ comp claim because:
- It believes you were not engaged in work-related activity when the injury happened.
- It claims you were intoxicated, under the influence of a drug, or impaired in another way that voids insurance coverage.
- It claims you have a pre-existing condition instead of a new injury.
- It claims certain medical care is unnecessary.
Your attorney will work to find out exactly why you were denied coverage. Then, your Louisiana workers’ comp attorney will seek evidence, expert testimony, and other resources to challenge the insurer’s reason for denial.
How an Attorney Can Help With Your Workers’ Compensation Appeal
Our law firm will tailor our services to your specific appeal, but we are prepared to:
- Secure evidence from the work-related accident: We will seek video footage, witness accounts, and any other evidence that helps prove your injuries or illness is work-related.
- Document your covered losses: Your personal injury lawyer will secure documentation for each of your covered losses, including medical care and lost income. With detailed documentation, an insurer cannot credibly claim that you are exaggerating your losses.
- Negotiate a settlement: We may be able to secure a fair financial settlement through negotiations with the insurer. Your workers’ comp lawyer will contact the insurer to see about the possibility of settling.
- Schedule and attend your hearing: If a hearing proves necessary, we will schedule the hearing. Our team will complete the pre-hearing process, prepare you for the hearing, and attend the hearing alongside you (or on your behalf).
- Take any other steps necessary to pursue your financial recovery: Our firm will strive to obtain the benefits you deserve, and we will exhaust every available legal option. With significant financial resources and a team of dedicated attorneys, we will fight until we achieve the resolution you deserve.
For decades, Laborde Earles has helped injured and sick workers in Louisiana obtain the benefits they deserve. Trust us to fight for you.
Workers’ Compensation Benefits You May Receive Compensation For
The Louisiana Workforce Commission explains that those injured on the job may receive workers’ compensation benefits for:
- Medical bills
- Lost wages
- Disability-specific expenses
- Rehabilitation services
- Death benefits
Depending on the circumstances of your work-related ailment, you may be able to file a lawsuit against liable third parties. In this case, you may be entitled to compensation for additional damages, including pain and suffering. Your Louisiana workers’ compensation attorney will discuss this possibility with you.
Call Laborde Earles Today for a Free Consultation
If you have suffered injuries or become sick due to work-related conditions, a Louisiana workers’ compensation lawyer from our firm will fight for the benefits you deserve. We help with both initial claims and appeals. We can assist regardless of where you are in the workers’ comp process.
Contact us at Laborde Earles today for your free consultation.
