What to Do If Your Workers' Compensation Claim Was Denied in DC
Learning that your D.C. workers’ compensation claim was denied can be a significant blow to your life and livelihood. You may be wondering how you’ll afford necessary treatments or support those who depend on you. While a denial may seem like the end of the line, the truth is that it does not mean your claim is doomed. With the help of a skilled workers’ compensation attorney, you may be able to appeal your denied claim and collect the benefits you deserve.
At Trollinger Law LLC, we understand that obtaining workers’ compensation benefits can be essential to keep you physically, emotionally, and financially healthy. We help injured workers throughout D.C. to recover benefits so that they can heal without worry. If you’ve been denied, Attorney Matt Trollinger will work to get your workers’ comp claim back on track.
Questions? Get the answers you need by calling us for a free case review.
Why Was My Workers’ Comp Claim Denied?
If you received a letter from the insurance company notifying you that your claim was denied, it should contain an explanation of the reasoning behind the decision. Sometimes a claim is denied simply because certain eligibility requirements were not met or because of other administrative mistakes. No matter the reason given, if you believe the denial is somehow unjustified, you may consider appealing the decision.
Some other common reasons for workers’ compensation claim denials include:
- Non-compensable or ineligible injuries: In some areas of the U.S., injuries that result from stress, psychological conditions, or trauma accumulated over time can be difficult to prove or are ineligible for workers’ comp benefits. In other cases, minor injuries may not be considered severe enough for injured parties to receive compensation.
- Unexplained or pre-existing injuries: If you have a pre-existing condition or you failed to explain how your injury was a result of the regular duties of your job, an insurance provider can exploit that in an attempt to deny responsibility for your claim.
- Lack of supporting medical records: Insurance providers typically have the right to request your medical records as they evaluate your claim. If you fail to submit your records to the insurer, or if they fail to receive them for any reason, they may use this as a reason to deny coverage.
- Failure to promptly report injuries: In the District of Columbia, employees are expected to report work-related injuries within 30 days of the injury or within 30 days of the realization that their injuries were job-related.
- Failure to promptly file a claim: If a work-related injury is severe enough to require treatment, any resulting claims for workers’ compensation coverage should be filed within one year of the date of the accident.
- Employer disputes the reason for your claim: In some cases, your employer may argue that your injury did not happen at work, that the injury was not job-related, or that you engaged in horseplay or another disqualifying behavior prior to being hurt.
How to Appeal a Denied Workers’ Compensation Claim
If your workers’ compensation claim was denied or if you were not offered adequate benefits, you may be wondering how to fight this decision made by the insurance company. The message you received notifying you of the denial should also contain information about the workers’ comp appeals process. Filing an appeal allows you or your employer to officially dispute the outcome of your claim if one of you feels that the decision was unfair.
Appealing a determination is a complex process that requires superb attention to detail and legal procedures. An experienced D.C. workers’ compensation lawyer can help guide you and pursue the maximum compensation available for your injuries by:
- Requesting a conference with the Office of Workers’ Compensation: Immediately after your claim is denied or inadequately settled, your attorney can help you request an informal conference with the DC Office of Workers’ Compensation. Here, a claims examiner will work with you and your employer’s insurance company to mediate or recommend a new settlement within 30 days of the meeting.
- Requesting a formal hearing with the Administrative Hearings Division: If your conference does not have the desired outcome, you may decide to file an application for a formal hearing of your case. Hearings are normally scheduled within 90 days of requests and include evidence from both you and your employer. Judges typically issue Compensation Orders within 20 days of a hearing.
- Submitting a request for review from the Compensation Review Board: If the Compensation Order issued is still not sufficient, an attorney can help you submit a request for review from the Compensation Review Board. These requests must be submitted within 30 days of an Administrative Hearing decision, and reviews are conducted by a panel of judges.
- Submitting a request for consideration to the Compensation Review Board: If the final decision of the Compensation Review Board does not fully meet your needs, you have an additional 10 days to submit a new request for consideration. This request will prompt the review board to consider your case one more time.
- Filing an appeal with the D.C. Court of Appeals: If your benefits determination is still not appropriate for your circumstances, you have an additional 30 days from the date of the Compensation Review Board’s decision to file an appeal with the District of Columbia Court of Appeals. Your workers’ compensation attorney will then help you argue your case for you in a court of law.
How to Prove a Workers’ Comp Injury
One of the most important ways to secure the workers’ compensation payments you deserve is by collecting and providing solid proof of your injury or illness. A seasoned workers’ compensation attorney can assist you in gathering evidence. Examples include:
- Photographs of the accident scene and your resulting injuries
- Video footage, if your workplace is equipped with security cameras
- Statements from co-workers, customers, or other eyewitnesses
- Time logs indicating that you were on the clock when you were injured
- Maintenance and inspection logs for any equipment involved in your injury
- Doctor’s office reports and other historical records of medical treatment
- Prescriptions or other treatment referrals related to your injury
You will also need to prove that you notified your employer of your injury and filed all resulting claims on time. It’s a good idea to make copies of any formal notifications you issued or claims you filed in case your timeliness comes into question later on.
How Many Times Can I Appeal My Claim?
Appealing a workers’ compensation claim has many stages. But you can’t appeal a claim indefinitely. Much depends on the decision handed down by the D.C. Court of Appeals.
If the D.C. Court of Appeals affirms the decision of the lower Compensation Review Board, the decision to deny your appeal will most likely be final. If the Court of Appeals reverses the decision of the Compensation Review Board, your case may be sent back to the formal hearing stage, where it will also could begin again.
The options available to you can be difficult to understand and may change at each level of the decision-making and appeals process. The best way to navigate these complicated procedures and tight deadlines is to seek the advice of a dedicated workers’ compensation lawyer.
How a Workers’ Compensation Attorney Can Help With Your Appeal
It’s always in your best interest to speak with an attorney immediately if you seek to appeal a workers’ compensation claim. In addition to helping you understand the appeals process and adhere to an array of crucial legal deadlines, a workers’ compensation lawyer can help you by:
- Providing advice based on years of experience
- Gathering and presenting compelling evidence
- Interviewing coworkers and other witnesses to your workplace accident
- Speaking or writing on your behalf
- Negotiating appropriate settlement agreements
- Representing you in hearings and in court
Get Legal Help From a Washington, D.C. Workers’ Compensation Lawyer
At Trollinger Law LLC in Washington, D.C., we put you first. Our legal team has in-depth knowledge of D.C. workers’ compensation laws and can get started on your appeal immediately. If you feel your workers’ compensation claim was wrongfully denied, call or contact us now.