Even though you’ve gone through all the steps to report a workplace injury and file a workers’ compensation claim, that claim may be denied by the insurance company. Remember, it’s the insurance company reviewing and deciding on these cases, not the State of Colorado. A denial might be a delaying tactic. Sometimes, portions of the claim may be denied—allowing for medical coverage but not loss of income.
If you decide to appeal the insurance company’s decision, the process is tricky and takes time and continuous attention. If you don’t already have an experienced workers’ comp attorney working with you on your claim, this may be a very good time to bring one on board.
Initially, it can’t hurt to check with the insurance company to see if the denial was issued just on the basis of incomplete information. More often than not, though, the reasons for denial or partial payment are more significant, such as:
- No medical proof or support for the claimed injury
- Incorrect classification of an injury
- Medical diagnosis was not from an authorized healthcare provider
- Information was not submitted on time by the injured party
- Employee had a pre-existing health condition
- Injury is not work-related
- Injury is minor
In the appeals process, the burden is on the victim to introduce new information that disproves these accusations. This new information must be presented in the right way and in the right settings. While you’re not required to have a lawyer represent you at the various stages of the hearing and review process described below, very few have the knowledge and experience to successfully represent themselves in these bureaucratic settings, places that insurance company attorneys work in every day.
As a first step, you can meet with the insurance agency to try to resolve the dispute. If these negotiations are not successful, you must request an Office of Administrative Court hearing before an Administrative Law Judge. If your appeal is denied there, you can petition for a review of the case by the state’s Industrial Claim Appeals Panel. Further appeals, if necessary, can be made to the Colorado Court of Appeals and even to the Colorado Supreme Court.
It’s important to keep fighting, because if you give up at any stage, the denial will remain in force, and you or your health care insurer will be liable for your medical expenses.
The good news is that if you have a legitimate workers compensation claim, and follow all the right steps on your initial filing and later appeals, there is a good chance that the workers’ comp system will serve you, the victim, as it is intended.
If your workers’ compensation claim was rejected and you’re considering an appeal, please contact the workers compensation attorneys at Frickey Law Firm for a free consultation.