When Your Workers’ Compensation Claim is Denied: Next Steps for Indiana Workers
A workplace injury can be overwhelming, and the financial stress only worsens when your workers’ compensation claim is denied. Unfortunately, many injured Indiana workers face claim denials, even when their injuries are legitimate and clearly job-related. If you find yourself in this situation, it’s important to understand that a denial is not the end of the road. Indiana law gives you the right to appeal, and with the proper steps and guidance, you can still secure the benefits you deserve.
At Lee Cossell & Feagley, LLP, we help workers navigate the workers’ compensation system and fight back when insurance companies refuse to do the right thing. Here’s what you need to know if your claim has been denied. Call our office for immediate assistance and to speak with an experienced Indianapolis workers’ compensation attorney.
Why Are Workers’ Compensation Claims Denied?
Understanding the reason for the denial is the first step in formulating an appeal. Insurance companies and employers often deny claims for reasons such as:
- Missed deadlines: Failing to report your injury within 30 days or missing the two-year deadline to file a formal claim can result in denial.
- Disputes about the cause of injury: Employers may argue that the injury did not occur at work or is not job-related.
- Pre-existing conditions: Insurers sometimes claim that your injury is due to a prior health issue rather than a workplace accident.
- Insufficient medical evidence: If your doctor’s records don’t clearly connect your injury to your job, your claim could be rejected.
- Failure to follow procedures: Not seeing the employer-approved doctor or failing to comply with treatment plans can also trigger a denial.
If you receive a denial letter, review it carefully. The letter should explain the reason your claim was denied and provide information about your right to appeal.
Filing an Appeal with the Indiana Workers’ Compensation Board
If your claim is denied or your benefits are terminated prematurely, you can appeal by filing an Application for Adjustment of Claim with the Indiana Workers’ Compensation Board. This form is your formal request for the Board to review your case and decide whether the denial was justified.
The deadline for filing this application is two years from the date of injury (or two years from the date of the last compensation payment, whichever is later). Missing this deadline could permanently bar you from receiving benefits, so it’s important to act quickly.
Once the application is filed, your case will be assigned to a judge, and the process of resolving the dispute will begin.
The Dispute Resolution Process
The Indiana Workers’ Compensation Board provides several opportunities for workers and employers (or their insurance companies) to resolve disputes:
- Informal Conference – In some cases, the Board may encourage the parties to resolve the dispute informally before a hearing is scheduled.
- Mediation – Mediation is a voluntary process where a neutral mediator helps the parties negotiate a settlement.
- Hearing – If no settlement is reached, the case will proceed to a hearing before a Workers’ Compensation Board judge. This hearing functions much like a trial, with both sides presenting evidence, medical records, and witness testimony.
After the hearing, the judge will issue a written decision. If either party disagrees with the decision, they can appeal to the full Workers’ Compensation Board and, ultimately, to the Indiana Court of Appeals.
How to Strengthen Your Appeal
A successful appeal often hinges on providing strong evidence that directly addresses the reason for denial. Depending on the circumstances, this may include:
- Additional medical documentation linking your injury to your job duties.
- Expert medical opinions to counter arguments about pre-existing conditions.
- Witness statements from co-workers who observed the accident or the hazardous conditions at work.
- Accident reports and photographs showing how and where the injury occurred.
Having a knowledgeable attorney on your side can be critical during this stage. An experienced workers’ compensation lawyer will know what evidence the Board expects and how to present it effectively.
Why Legal Representation Matters
Appealing a workers’ compensation denial can be intimidating, especially when you are dealing with serious injuries and financial uncertainty. Insurance companies have teams of lawyers and adjusters working to protect their interests; you deserve someone who will fight just as hard for yours.
At Lee Cossell & Feagley, LLP, we handle all aspects of the appeal on your behalf, including gathering evidence, communicating with the insurance company, and representing you at hearings. We understand the tactics insurers use to avoid paying benefits, and we know how to overcome them. Our goal is to relieve your stress so you can focus on healing.
Next Steps After a Denial
If your workers’ compensation claim has been denied, consider taking the following actions right away:
- Read the denial letter carefully to understand why the claim was denied.
- Gather all documentation related to your injury, including medical records, accident reports, and correspondence with your employer or the insurance company.
- Contact an experienced workers’ compensation attorney as soon as possible. The appeals process is complex, and legal guidance can make a significant difference in the outcome.
Do not delay, as deadlines apply at every stage of the process. The sooner you seek help, the better your chances of turning a denial into an approval.
Lee Cossell & Feagley, LLP: Advocates for Injured Indiana Workers
A denial of your workers’ compensation claim is not the end. With the right legal representation, you can fight back and secure the benefits you are entitled to under Indiana law.
The attorneys at Lee Cossell & Feagley, LLP, have decades of experience standing up for injured workers in Indianapolis and statewide. We know how to navigate the appeals process and build the strongest possible case for our clients.
If your claim has been denied, do not give up. Contact us today for a free consultation to learn how we can help you challenge the denial and obtain the medical care and wage replacement you need.
