Understanding The Workers Compensation Administrative Hearing Process

If you have worked for a company that employs enough people to require workers compensation insurance, then you have a legal right to compensation if you are injured at work. While this is true, the filing process can be difficult for some. If you have tried to file for workers compensation and have recently received a rejection on your claim, then you should know that you can appeal this decision. This requires you to go through an administrative hearing. If you want to do this, then keep reading to learn some important things you will need to do during the process.

Understand The Reason For Denial

Unfortunately, legitimate injury claims are denied daily by companies that provide employers with workers compensation insurance. The good news is that the initial denial is not the final decision regarding your claim. You can go through a hearing where The Administrative Hearings Division of your state's Department of Employment Services or Department of Labor will listen to your case. 

By law, the insurance company denying your claim must provide you with a valid reason for the denial. The reason will be listed on your insurance paperwork. It is extremely important to find this reason and to understand it. 

There are a variety of common reasons why your workers compensation claim may be denied. It is possible you waited to report your injury, the incident was unwitnessed, or your medical records do not completely verify that the incident occurred the way you reported it. The recorded finding of drugs in your system, the report of an accident after you were fired, poor communication with physicians, not authorizing insurance companies to access your records, and missing paperwork are common reasons for a denial as well.

Remedy The Denial

Certain reasons for denial, like not authorizing medical records to be seen and missing paperwork, are easy to remedy. Make sure to fill out the appropriate forms and gather all documents well before your administrative hearing. 

Other reasons for denial are not as easy to combat, like if the incident was unwitnessed or you failed to report the incident immediately. Thankfully, a judge will decide whether or not there is enough evidence in your case to determine if an injury did occur. This means you can bolster your case with statements of why you may not have reported the injury right away or with diagrams, models, and more in-depth statements to explain exactly how the injury occurred, even if there were no witnesses. If you are confused about a good way to present your evidence, speak with a workers compensation attorney from a place like the Walz Law Office for assistance. 

Even if evidence is not clear, but the judge concludes that an injury likely did occur, then you will receive some compensation, even if it is not 100% of your initial claim. 

File The Right Paperwork

Once you understand the reason for the denial and how to remedy it, you do have the right to file for an administrative hearing. You can also drop your workers compensation claim if you desire. If you do decide to move forward, you will need to fill out and file paperwork. Your administrative hearing will not be automatically scheduled once you receive your denial in the mail. Many people believe that this is the case and you may miss the filing date for the hearing if you wait. 

Most denial paperwork will state exactly what you need to do to set up an administrative hearing. Read the denial letter very carefully, because the deadline for the filing date will usually be printed on the letter. Every state will have a different timeline for the appeal process. For example, in New York you must file for appeal within 30 days of your denial, whether it is supplied by the insurance company or a judge after a formal hearing. While this is the case, your hearing date is likely to be scheduled at least a month or two after the filing deadline. This is often due to busy judicial schedules, and this will give you time to prepare for the official hearing.