How to Appeal Denied Workers Compensation Benefits

This week, we will complete our 3-post series on Filing for Benefits under Workers Compensation by concentrating on the Appeals process. While anyone can file an appeal, the process can be complex, time-consuming and risky at best. If you’re considering filing an appeal, contact a Montagna Law attorney today for a free legal consultation. Workers Compensation attorney fees are paid using a percentage of any financial benefits received, so there’s no reason to go it alone – call us today!

As we discussed previously, there are many careless mistakes or unfortunate circumstances that can result in your workers compensation claim being denied. Naturally, there are also a few legitimate reasons that these claims get turned away.

Legitimate reasons workers comp claims can get denied:

• Injury occurred outside of work environment, in non-work related activity
• Doubts as to whether or not the injury actually occurred
• Discrepancies as to how/when/where the injury occurred
• Injury caused by pre-existing condition or tendency
• Conclusion of “no disability” by licensed health care provider

If any of these reasons apply to your case, an appeal may not be helpful. But if you are confident that your case has merit and want to proceed, then you should begin your appeal as soon as possible.

Before Filing your Appeal:

• Contact your insurer and ask why your claim was denied. It sounds too simple to be effective, but occasionally the omission of one document can result in a denial. If you’re sure you’ve completed all of the paperwork and met all of the deadlines, as your insurer to reconsider your claim.
• Hire a workers compensation attorney. Trust us; with all of the documents, coordination between witnesses and medical professionals and court dates, you’ll need a lawyer just to keep you in the game.

First Level of Appeal: Deputy Commissioner

• File a formal appeal and a “Claim for Benefits” form with the Virginia Worker’s Compensation Commission.
• You and your attorney will attend a Hearing with the Deputy Commissioner, complete with witness testimony and physical evidence. The evidence presented during this hearing will be the only evidence permitted in subsequent hearings or trials, so be thorough and come prepared.
• This is where your attorney will prove his or her value: gathering the necessary documents (injury reports, evidence of work missed due to injury, medical documentation of inability to work) as well as coordinating witnesses (when was the last time your doctor stuck around for longer than forty-five minutes, or for that matter, met you outside of the office?). Your Montagna Law workers compensation attorney will take care of the massive preparatory work that goes into the hearing, so that you can focus on healing.

A written decision will be issued by the Deputy Commissioner approximately 3 weeks after your hearing. If your claim was again denied, you can appeal to the Full Commission.

Second Level of Appeal: Full Commission

• File a “Review” appeal within 30 days of receiving the decision of the Deputy Commissioner.

No new evidence will be allowed during this level of appeals, which is why it is so important to be prepared for the Deputy Commissioner hearing. You will not be permitted to submit any new evidence or bring forward any new witnesses; you may not even be allowed to testify for yourself. If oral arguments are not allowed, you will receive a written notice in the mail containing the Full Commission’s decision. If your claim was once again denied, your next stop is the State Courts of Appeal.

Third Level of Appeal: State Courts of Appeal

• File a “Notice of Appeal” with the clerk of the commission*
• File a “Notice to Clerk of Court of Appeal” with clerk of appeal*
• Must pay a $500 appeal bond*
• Must pay $50 filing fee*

*Each of these forms and fees must be taken care of within 30 days of receiving the decision of the Full Commission.

Fourth & Final Level of Appeal: The Virginia Supreme Court will decide whether or not to hear your case.

As you can see, filing an appeal is not a simple, easy process. It is lengthy, convoluted and riddled with potential oversights. If your workers compensation claim has been denied and you’d like to file an appeal, contact Montagna Law today for a free legal consultation. Don’t suffer in silence, and don’t give up on what’s right. Our experienced and aggressive workers compensation attorneys will identify reasons why your claim was denied, gather evidence, keep track of documents and corral witnesses as well as medical experts to testify on your behalf. Remember, you are not required to have legal representation, but your employer is. 

Don’t let the big insurance companies push you around and deny your rights after you’ve been injured. Contact Montagna Law today.

Montagna Law Workers Comp Attorneys:

Charles Montagna

Amber Russo