Many injured employees count on workers’ compensation benefits to cover their financial losses after an accident. However, the system sometimes denies claims. Our team at Jason Stone Injury Lawyers can tell you what to do if your workers’ compensation claim is denied.
Generally, the professionals recommend contacting a Boston workers’ compensation lawyer in this situation. An attorney can help you appeal your denied claim and explain further steps, including a hearing or meeting with the reviewing board.
Go over all your potential options by calling or completing our online contact form 24/7.
What’s Your First Step After a Workers’ Compensation Claim Denial?
You can file an appeal for your denied workers’ compensation claim. You can appeal the denial in person or through the mail. In order to file an appeal, you’ll need to provide extensive supporting documents.
The Department of Industrial Accidents (DIA) will expect you to tell them:
- The date of your accidental injury
- The date of your first day of missed work
- The date of your fifth day of missed work
You’ll also need to provide information about the workers’ comp insurance carrier used by your employer, the location of your injuries, and the kind of benefits you want. The DIA will want to know how long you plan to take off work, where you sought medical care and your current doctor.
You Need Supporting Documents to Appeal a Denial
The DIA expects you to provide supporting documentation when you appeal the denial of a workers’ comp claim. Documents may include:
- Witness statements
- The names of the witnesses
- Reports that detail the events of the accident
- Medical reports
- Your unpaid medical bills
You will also need to complete Form 110 – Employee Claim. Ensure you have three copies of the form and all supporting documentation before proceeding.
How to File Your Appeal
You can mail your Form 100 and any supporting documents to the DIA. You may also bring the form and documents to the DIA office in Boston.
What Happens After You File an Appeal?
Once you appeal a workers’ comp denial, the DIA will review the documentation you provided. The DIA may reject the form and return everything to you if they do not agree with the appeal. The DIA will include information about why they’ve returned your form.
Alternatively, the DIA may accept your appeal. However, accepting the appeal does not mean the immediate approval of your workers’ comp claim. Instead, the DIA will set up a meeting with a conciliator to review your claim further.
Hiring a lawyer to help you file for workers’ compensation in Massachusetts may help you avoid this process.
What Is Workers’ Compensation Conciliation in Massachusetts?
The DIA may schedule you for conciliation if you protest a claim denial. This informal meeting involves a professional conciliator who will attempt to help you and the insurer come to an agreement.
The DIA strongly recommends that you bring a lawyer to the conciliation attempt, which could lead to the resolution of your dispute and compensation for your losses. However, your employer’s insurer may continue to refuse your claim.
The DIA may set up a conference in this situation to further appeal the decision.
What to Expect at a Workers’ Compensation Conference
Sometimes, workers’ comp appeals go to a conference (or proceeding). This informal meeting takes place before an administrative judge who can issue a temporary order based on the conference results.
The administrative judge may not agree with your request. In this situation, you can file an appeal of the judge’s order. You only have 14 days to file this appeal, which can lead to a workers’ comp hearing.
What Happens at a Workers’ Compensation Hearing?
In some cases, you may request a full evidentiary hearing after a workers’ comp denial. During this hearing, your lawyer may question witnesses and present evidence on your behalf, leading to a decision from an administrative judge.
Typically, before reaching this stage, you must participate in pre-hearing conferences. Your lawyer will provide more detailed information about these conferences.
If you do not agree with the decision from the hearing, you can appeal to the reviewing board. You only have 30 days to file this appeal after the hearing.
You May Go Before a Reviewing Board
Some workers go before a Reviewing Board from the DIA. Three judges will review the transcripts of your hearing in this situation. They may reverse a decision if they decide that the judge acted:
- Contrary to the law
- In a capricious or arbitrary way
- Beyond the scope of their authority
However, the Reviewing Board may uphold the decision of the previous administrative judge. In this situation, you could appeal to the Massachusetts Court of Appeals. A lawyer can discuss all these options in more detail.
We’ll stick with you throughout every step of the legal process as part of our Stone Cold Guarantee®.
Talk to Us About What to Do After a Workers’ Compensation Claim Denial
Wondering what to do if your workers’ compensation claim is denied in Massachusetts? Our team at Jason Stone Injury Lawyers can walk you through each step of the appeal process, working diligently to bring you fair damages to cover your losses.
You can reach out to us at any time of the day or night. Call or complete our online contact form to get personalized support.
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