What Happens If My Workers’ Compensation Claim Is Denied?

When you’ve been injured on the job in Colorado, you naturally expect that the workers’ compensation system will support you, providing benefits for medical expenses and loss of income. Sometimes, what should be a straightforward process becomes much more complicated when a claim is denied.

If your workers’ comp claim has been denied, it’s important to know that you have the right to dispute the decision. However, it is best to work with a Denver workers’ compensation lawyer who can present the best possible case on your behalf and fight for your right to fair benefits.

Reasons Why a Workers Compensation Claim May Be Denied

Understanding why a workers’ compensation claim was rejected is a critical first step toward addressing and possibly appealing the denial. Below are some of the most common reasons as to why a claim may be denied:

Lack of Evidence

Sometimes, there may not be enough evidence to support the claim. This could be due to insufficient medical documentation or a lack of witnesses.

Missed Deadlines

There are specific timelines within which a worker must report an injury and file a claim. Missing these deadlines can result in a denied claim.

Discrepancies in Statements

Inconsistencies between your account of the incident and what is reported by witnesses or in medical records can raise doubts about the validity of your claim.

Non-work-related Injuries

Colorado workers’ comp insurance only covers workplace injuries. If it’s determined that the injury didn’t occur at work or during a work-related task, the claim might be denied.

Prohibited Substance Use

Some claims are denied if the injured party was found to be under the influence of drugs or alcohol at the time of the accident.

How to Appeal a Denied Workers’ Comp Claim in Colorado

If your claim was denied, there are structured processes in place to help you appeal the decision. After a denial, you could file an Application for Hearing with the Office of Administrative Courts. This allows both you and your employer to present evidence before an administrative judge. This judge then evaluates the presented evidence and makes a final decision regarding the claim.

Before this formal hearing, you can also request a pre-hearing conference. This is an opportunity to exchange evidence before the formal hearing. Additionally, a settlement conference can be initiated, which offers a chance for you and your employer to reach an agreement without the need for a formal hearing.

Work with a Colorado Workers’ Compensation Attorney

Whether you are planning to appeal a denied workers’ comp claim or initiate a claim for benefits, you need an attorney on your side who can guide you through the process. A Colorado workers’ compensation lawyer can provide several benefits to support your case, such as:

Expert Guidance

An attorney has in-depth knowledge of the laws governing workers’ compensation claims. Your lawyer can guide you through the complexities of the process and make sure that you adhere to deadlines and requirements.

Document Preparation

Proper documentation can make or break a claim, and is essential when filing an appeal. An attorney can ensure that all necessary paperwork is filed accurately and promptly, and gather critical pieces of evidence to strengthen your case.

Representation at Hearings

Attending a hearing without representation can be intimidating. An attorney will represent your interests, ensuring that your side of the story is presented effectively.

After a workplace accident, don’t wait to seek help. Contact a Colorado workers’ compensation lawyer to discuss your next steps.