Learn about the appeals process for workers’ comp denials
Workers’ compensation is essential for workers hurt on the job trying to reclaim some normalcy. However, if your claim is denied, knowing how to appeal a denial is necessary to getting compensation for medical costs and time lost from work.
Your best chance of winning your workers’ comp appeal is to hire an experienced Arizona workers’ compensation attorney.
Continue reading to find out why.
Requesting a hearing
One of the most important things to know about how to appeal a workers’ comp denial is that you have 90 days to appeal to the Industrial Commission of Arizona’s (ICA) Claims Division. You can also file an appeal if you aren’t pleased with the amount you have been awarded.
The ICA will send you a notification of the date and time the hearing will take place. This date is generally within 3 months of making the request. Having an attorney working with you can provide better chances of reversing your workers’ comp denial and winning your appeal.
What is a pre-hearing conference?
Sometimes, the administrative law judge assigned to the case might require both parties to attend a pre-hearing conference. This conference gives the judge a chance to talk to both parties and is usually handled by phone. A judge will address during the conference whether you intend to use witnesses at your hearing.
Participation in this conference is mandatory when the judge makes this request. Failure to attend the conference might result in denied benefits. Even though the idea of a conference might seem overwhelming, an attorney who knows how to appeal denied cases can help.
What is discovery?
The discovery process requires participation by both parties before the trial. Your employer will also have their insurer representing their side. The 2 sides can exchange information, allowing for closer examination of the evidence.
During discovery, any doctors who have treated you will make medical records that include test results and other information on your injury available. You might also be required to give a deposition. Filing a motion for a protective order is possible if you object to the discovery process, but if denied, your case will be dismissed if you do not comply.
What happens at the final hearing?
The administrative law judge will give an overview of the dispute. Because the employee filing the appeal has the burden of proof, they will usually testify first. The judge will usually ask the first questions.
You should expect the insurance company’s lawyer to cross-examine you. In addition to being cross-examined, you can also cross-examine any witnesses that your employer and the insurance company call. A decision will usually come within 30 to 60 days, and all parties receive copies of the decision by mail.
How to prepare for your workers’ comp appeals hearing
The hearing will be the only chance that you’ll have to provide the evidence that gives you a more durable case. Evidence, such as records and notes from witnesses, can make a difference. Closely working together with your attorney can help make sure that your evidence is in order for presenting a compelling case.
Because testimony from witnesses present during the accident is helpful, you will need to consider who can help present your side the most effectively. Your lawyer will know what evidence your witnesses can provide that will be the most helpful. Another way your lawyer can help is by preparing you and your witnesses for cross-examination.
Knowing which questions you should ask the defense is another essential part of the preparation process. If you know what you are going to ask, there will be less chance of your getting caught off-guard. The more sure you are, the better you are likely to do during your hearing.
Are further appeals possible?
An employee who is unhappy with the judge’s decision can request a review within 30 days of receiving the final decision. The administrative law judge will issue a ruling after re-examining the evidence. Either the original decision will be confirmed or changed.
An employee who is still dissatisfied with the decision can appeal to the Arizona Court of Appeals within 30 days of receiving the decision from the review. As with the original hearing, the right lawyer can play a significant role in the outcome of your case.
What are my chances of winning a workers’ comp appeal?
According to an analysis of workers’ comp claims from 2013 to 2017 by Engineering News-Record (ENR), only about 7% of workers’ comp claims are initially denied. Of those, about two-thirds are paid within 1 year.
This means that 2 out of 3 workers whose claims are denied will likely win their cases on appeal.
So how can you help ensure that you’re one of the two-thirds of workers whose appeal ends in victory?
Well, for starters, your chances of winning a workers’ compensation appeal are significantly improved if you follow the correct procedures, such as those outlined below:
- Timely reporting of the injury. Reporting the injury promptly to your supervisor and doing so in writing creates a documented record of the incident. This can make it more difficult for an employer or insurance company to dispute the claim later.
- Seeking medical treatment. Obtaining medical care, even for seemingly minor injuries, provides medical records and professional assessments that can substantiate your claim. The medical documentation can serve as evidence of the injury’s existence, cause and severity, supporting your need for compensation.
- Gathering comprehensive evidence. By maintaining a detailed record of events, including dates, times, photos and witness statements, you create a strong foundation for your claim. This evidence can corroborate your account of the incident and counter any attempts to challenge the validity of your claim.
- Avoiding social media posts. Being cautious or avoiding social media altogether can ultimately help you win your appeal. Workers’ comp insurance companies often monitor your online activity, and even seemingly innocent posts of you out to dinner with friends or pushing your child in a swing at the park can be used against you if they appear to contradict the extent of your injuries or the nature of the accident.
- Engaging legal representation. An experienced workers’ compensation attorney understands the complexities of workers’ comp law and can help you navigate the process effectively. They can assist in gathering evidence, negotiating with insurance companies, and ensuring that all required procedures are correctly followed. An attorney can also counter any lowball offers with well-supported arguments based on the evidence and law, increasing your chances of a favorable settlement.
By adhering to the correct procedures, you demonstrate that you’ve acted responsibly and in good faith, which can create a more favorable impression with the claims adjuster, judge, or any other parties involved in the appeal.
Questions and answers about compensation for a job-related accident, injury or illness in Arizona
Hire an experienced Arizona work injury attorney to appeal your case
There’s no doubt that being injured on the job hurts, both physically and financially. Because this situation is so difficult, you want to increase your chances of winning your workers’ comp appeal.
Contacting an attorney as soon as possible is recommended to increase your chances of securing the best possible outcome.
At the Law Offices of Robert E. Wisniewski, our attorneys have extensive experience negotiating with insurance companies and successfully arguing our injured clients’ cases in court throughout Phoenix.
Contact the Law Offices of Robert E. Wisniewski today for your free consultation.
