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What can you do after a denial of your workers' comp claim?

What can you do after a denial of your workers' comp claim?

You've worked hard, possibly for many years at the same job. You put in your hours, and you contribute to the ongoing success of your employer. Then, there's an accident at work. Maybe it was a machinery issue, or perhaps you experienced a slip-and-fall. There are countless ways to end up injured at work, which is why workers' compensation exists. This specialized insurance helps ensure that those who work don't end up in poverty due to a work-related injury.

You know you did everything that you should have. You immediately reported the injury to your supervisor or manager. You sought on-site medical assessment (if your employer provides it). You then followed up with care from a local hospital or your own doctor. In order to obtain workers' compensation coverage, you filed a claim, as required under Massachusetts law. However, after a week or two, you got a letter in the mail advising you of the denial of your claim. Now you have to appeal that denial.

Why do workers' compensation claims get denied?

Some rejections have to do with mistakes on the part of the person filing the claim. Sometimes, a rejection of a workers' compensation claim has to do primarily with a mistake or error on your claim form. These documents can confuse many people, and mistakes are common. Forgetting to include a piece of information can also cause a rejection. These issues are usually quickly addressed in the appeal process, provided that you have adequate documentation of everything.

Sometimes, communication issues with your employer could result with a denial. If your supervisor or manager didn't file necessary paperwork with human resources, there may not be a record of your accident at work. That could lead your employer to deny your claim. Sometimes, employers deny claims even when everything was done properly in the hopes that they can avoid an increase to their workers' compensation insurance premium. That can leave you, the worker, in a difficult position.

You have the right to an appeal

Under Massachusetts law, you have the right to appeal in person at the Department of Industrial Accidents in Boston by bringing in all necessary paperwork. You can also appeal by mail by submitting forms and documentation that way.

Generally speaking, you will need information about the date of your injury and missed days of work (including the first and fifth days you miss), the name of your employer's workers' compensation insurance carrier, the nature and location of your injuries, the benefits you're seeking and the anticipated recovery time, as well as the names of the medical professionals who have treated you. After the review of your documentation and forms, you may get invited to an informal meeting with a conciliator to discuss the claim.

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