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Appealing a workers’ comp benefits denial takes patience

On Behalf of | Oct 16, 2020 | Worker's Compensation

The notification was startling. Your application for workers’ compensation benefits was denied by your employer’s insurance company. This does not make sense. You suffered a severe injury on the job and are temporarily unable to work. You filed your application and waited. But you got an unexpected answer.

Let the anger and shock subside, and then pursue your next step: filing an appeal. You must understand that, sometimes, employers and insurance companies collude in an attempt to ensure the denial of workers’ compensation benefits.

A process that escalates

Filing an appeal and resolving your case entails a lengthy and escalating process. Here are the steps involved:

  • Gather all information. This would include the date of injury, type of injury, treatment sought, names of treating physicians, all medical reports, the name of your employer’s insurance company, the dates that you were unable to work, and witness names and statements.
  • Send the information to the Massachusetts Department of Industrial Accidents (DIA). This governmental body oversees workers’ compensation claims.
  • Conciliation scheduled. The DIA then sets up a meeting with you, your attorney, an insurance company representative and a conciliator in an effort to reach an agreement. If an agreement does not occur, the parties set up a conference.
  • Conference scheduled. During this meeting, an administrative judge hears your case. If a resolution occurs, the judge issues a temporary order declaring whether the insurance company must pay benefits. If neither you nor the insurance agree with the judge’s decision, the parties have 14 days to appeal.
  • Evidentiary hearing slated (if conference decision is appealed). Witnesses testify and evidence presented by an administrative judge. If you or the insurance company do not agree with the judge’s decision, you have 30 days to appeal to the DIA’s Reviewing Board.
  • Reviewing Board hearing: Here, three administrative judges review records from previous hearings. They can affirm the decision or remand it to the administrative judge for additional review.

But remember that during every step of an appeal, you should be present with a skilled attorney. A legal ally can provide guidance and answer questions you have.