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How to Appeal a Denied Workers’ Comp Claim

How to Appeal a Denied Workers’ Comp Claim

On Behalf of | Jun 17, 2019 | Workers' Comp |

If you are out of work because of an on-the-job injury, you expect that your lost wages and medical bills will be covered by workers’ compensation. Every day you go without your benefit is a financial hardship—and if your claim has been denied, it just compounds the economic and emotional stress.

There are steps you can and should take as soon as you receive an Insurer’s Notification of Denial—Form 104, or if you have not heard from the insurer within 30 days of the accident:

  1. Make sure you have all information on hand, including:
    • The date you were injured
    • Your first calendar date of missed work
    • The fifth calendar date of missed work
    • The name of your employer’s workers’ compensation insurance carrier
    • The type of injury and on what part of your body you were injured (for instance, a compound fracture of the right tibia)
    • What benefit you are seeking
    • If you know it: how long you’re expected to be out of work
    • Where you initially went for treatment
    • The physician who is currently treating your work-related injury
  2. Obtain and complete a copy of Form 110—Employee Claim. Be as thorough and accurate as possible and attach copies of medical evidence such as physician’s notes, doctor or hospital bills, a copy of the claim sent to the insurer and any other pertinent information. Make sure you keep copies of everything. You can either send everything to the Department of Industrial Accidents or bring it to them in person.
  3. It is imperative that everything is correct and thoroughly filled out. An incomplete or inaccurate form will be returned to you, further delaying your claim.
    • If the paperwork and documentation is accepted, a Conciliation is scheduled. This is a meeting which involves your attorney, the insurer’s attorney, and a conciliator from the Department of Industrial Accidents. The purpose of the meeting is to come to an agreement.
    • If agreement cannot be reached, the next step is a Conference, before an Administrative Judge. This also involves you, your attorney and the insurer’s attorney and an administrative judge. If outstanding points of contention from the Conciliation are resolved, the judge issues a temporary Conference Order to have the insurer pay you benefits. If the insurer objects or wishes to modify benefits, that will be addressed in the order. All parties have 14 days to appeal the order.
    • If an order is appealed, the case goes to a Hearing. This is basically a trial in which evidence is submitted and witnesses heard. The judge makes a hearing decision based on the evidence and testimony. Either party may appeal the decision within 30 days.
    • The next appeal goes to the Department of Industrial Accidents Review Board. The board may accept the administrative judge’s decision or send a decision back to the administrative judge for more fact-finding. The board only overturns a decision if they believe the decision was arbitrary or capricious, outside the scope of the judge’s authority or contrary to law.
    • If all other appeals fail to satisfy either party, it may go to the Massachusetts Court of Appeals or, ultimately, the Massachusetts Supreme Court.

Legal counsel is recommended to help ensure a positive outcome for you in workers’ compensation denial cases

A skilled and knowledgeable Massachusetts workers’ compensation lawyer who advocates for you offers the best chance of getting a successful appeal. For more information, contact the office of Chisholm Law LLC online or call us at 978-942-6959 today.
About the Author: Eric Chisholm
J. Eric Chisholm practices in the areas of Personal Injury, Workers’ Compensation and Social Security Disability. He is a member of the Massachusetts Bar Association & a frequent lecturer on the topic of workers’ compensation law at Massachusetts Continuing Legal Education seminars.