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Appealing Workers' Compensation Claim Denials: What Are the Steps?

Matt Murphy Jan 12, 2018

Rejection of a workers' compensation benefit claimAfter being injured on the job, many people rely on workers’ compensation benefits to help with medical expenses and with the daily cost of living. This money can help a person make ends meet while they are recovering from a serious injury. Sadly, sometimes workers are denied these benefits, which can lead to numerous hardships.

The legal team at Murphy Law Firm can help you if you have been denied workers’ compensation benefits. The process can be involved, and having an attorney on your side can be extremely beneficial. Let’s consider the various steps in the appeal process to give you and idea of what challenges you may face.

Why a Claim Might Have Been Denied

Not filing on time is one of the most common reasons why a workers’ compensation claim is denied. It’s important that an injury be reported by both the worker and the employer as soon as possible in order to avoid denial of benefits.

In other cases, an injured employee’s employer may be responsible for the denied workers’ compensation claim. The employer may contend that the accident and injury did not happen, or that the incident at work did not cause or contribute to an injury. Gathering additional evidence and witness testimony from co-workers may be necessary to address these kinds of issues.

Other reasons for denied claims may have to do with the nature of the injury, the relative lack of severity of the injury, and so forth. The claim denial letter should specify the reason(s) for your claim being denied.

When to Appeal a Denied Claim

If you would like to appeal a denied workers’ compensation claim, it should be done as soon as possible after receiving the claim denial letter. The process may be involved, and it’s best to get the wheels in motion sooner rather than later.

Step One for Appeal: Send a Letter to the Insurance Company

Before requesting a hearing about your claim, you need to send a letter to the insurance company. This letter should explain why you disagree with the denial of your workers’ compensation claim and what benefits you are entitled to. If you do not hear back from the insurance company in 15 days, you move on to a mediation conference.

Step Two for Appeal: Mediation Conference

To request a mediation conference, a person must first file a Petition for Mediation Conference with the Mediation Unit of the Montana Department of Labor & Industry. A third party will contact you and the insurance company to try to work out some kind of solution to this dispute.

Step Three for Appeal: Petition for a Hearing

If you and/or the insurance company reject the recommendations of the mediator, you must then file a Petition for Hearing with the Montana Workers’ Compensation Court. This must be done within two years of the initial denial of your claim. A scheduled hearing will allow a judge to review the disputed details, and for both sides to present their respective cases. A judge will then make a ruling.

Step Four for Appeal: Go to the Montana Supreme Court

If the Workers’ Compensation Court judge does not rule in your favor, you can appeal the decision to the Montana Supreme Court. The Montana Supreme Court will review the judge’s decision and determine whether it should be upheld.

Contact Murphy Law Firm

For more information about appealing a denied workers' compensation claim and fighting for your legal rights, be sure to contact an experienced workers compensation lawyer today. The entire team here at Murphy Law Firm will be sure to answer your questions and address your concerns in full.

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