After suffering a workplace injury, you immediately rely on your workers’ compensation benefits to cover your injury-related expenses. However, you might still face denial after doing all the necessary procedures. It often happens when the claims administrator deems your injury ineligible for coverage.
You can challenge their decision after receiving a denial letter for your claim. However, you should do so as soon as possible to meet strict deadlines for filing forms.
Additionally, you can contact the Department of Industrial Relations’ information and assistance unit if you need help with your claim.
What should I do next?
The process of contesting your claim’s denial is simple. Here are the next steps you could take after receiving a denial letter:
- File a case at the correct Division of Workers’ Compensation (DWC) office.
- Receive a notice of confirmation with your case number.
- Request a hearing by filing a Declaration of Readiness to Proceed.
- Receive a hearing schedule, also called a mandatory settlement conference.
The hearing can end in different ways. Initially, the judge will help you and the claims administrator reach a settlement.
If you cannot agree, you will need to prepare additional paperwork detailing your dispute, including information about witnesses and what you will present to support your case. Then, the judge will identify a date for your trial.
What happens after the trial?
After attending the trial, the judge will finalize a decision, usually sent by mail after 30 to 90 days. If you or the claims adjustor disapprove of the judge’s decision, either of you can file a petition for reconsideration.