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.