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How to Appeal a Worker's Compensation Decision


Most workplace injuries are covered under your employer’s workers’ compensation insurance. However, if your injury claim is denied, you still have other options to get benefits. In this blog, we explain what you need to do to appeal a denied workers’ compensation claim.

Why Do Workers’ Comp Claims Get Denied?

If your claim ends up being denied, you need to find out what reason caused the denial. The reasoning for the decision should be in the denial letter. Sometimes you can be denied for simple things, like not meeting requirements for eligibility or missing deadline. If you think the denial is a mistake, you can appeal.

The flowing are common reasons workers' comp benefits are denied:

  • Your injury wasn’t reported on time
  • Your claim wasn’t filed on time
  • Your employer is disputing your claim
  • Your particular injury is not compensable
  • You didn’t obtain medical treatment
  • There’s not enough evidence to prove your injury is related to your work

What Should I Do if My Claim Is Denied?

You shouldn’t give up your right to worker’s comp just because you get a denial letter. Review the letter closely and find out exactly why your claim was denied. If it looks like it might be a paperwork error, contact the claims adjuster to find out if the issue can be cleared up. Unless your employer or their insurance company made a legitimate error, you will more than likely need to appeal the denial.

How to Appeal a Denied Claim

The letter you received denying your claim should also include information about how to appeal the decision. Read this section carefully because the appeals process varies from state to state. The first level of the appeal is usually at a hearing before an administrative law judge. At this hearing, you’ll have the opportunity to present medical and other types of evidence to support the validity of your claim. Your hearing might be with a state labor department or a state board of workers’ compensation. Depending on what state you live in, the additional levels of appeal after your hearing will vary.

Do I Need an Attorney to Appeal?

Appealing a denied claim can be a complicated legal process that is best handled by a lawyer who is familiar with workers’ comp law. Unless your claim was denied because of an error that can be easily remedied, you will want to have an attorney by your side to advise the best course of action for your particular situation. The timeline for appealing your claim is short and strict, a lawyer can make sure you don’t miss any deadlines and end up losing your benefits.

At the Law Offices of George P. Escobedo & Associates, PLLC, our friendly legal professionals will explain the rules of evidence and civil procedures to you, so that you understand every aspect of your case. We understand how distressing it can be to get injured and find yourself unable to return to work, which is why we are here to fight for the benefits you are entitled to. We are committed to helping injured workers across all occupations. Let us use our skills, experience, and legal knowledge to pursue your workers’ compensation benefits.

Contact our San Antonio workers' compensation lawyer to request your consultation today.

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