Was your workers’ compensation claim denied? Do you want to appeal a denied workers’ compensation claim in Virginia? Schedule a FREE consultation with Lugar Law PC today to discuss your options with a workers’ compensation attorney. Call (540) 384-0348 or fill out our online form.
If you were injured while working, or have recently been diagnosed with a work-related medical condition, you likely began the workers? compensation claim process. You might expect to have your medical costs covered and to start receiving wage benefits only to have your claim denied by your employer or their workers? comp insurer. This is known as a disputed claim, and you will need to take steps to contest the decision, including requesting a hearing before the Virginia Workers? Compensation Commission. After a hearing, if the Workers? Comp Commission denies you benefits, you have the option to appeal their decision in order to obtain benefits.
To speak with a lawyer about appealing a workers? comp denial, contact Lugar Law PC at (540) 384-0348 or through our online form. Our experienced Roanoke workers? compensation lawyers are here to fight for you to receive the help you need following a work accident.
Contesting a Workers? Comp Decision
If you file a workers? comp claim and your employer or the insurance company denies/investigating that claim, then you may have to have a hearing at the Workers Compensation Commission in order to get a decision on whether your claim is compensable. This involves requesting a hearing before the Virginia Workers? Comp Commission. At the hearing, your attorney will present evidence that your claim should be accepted and paid by your employer and their insurance company.
There are times when your employer may accept the medical portion of your claim, but deny wage loss or other portions. In this situation, you may have to try the case in part, but not all, to obtain an award for the claim. An attorney can help you gather the information necessary to prove that you deserve full benefits on your workers? comp claim.
There are also instances where an employer may pay claims for a period of time in order to make you think you have been approved. Once important deadlines have passed, the employer will try to deny the claim or stop paying it. There are opportunities now in law that will allow you to contest or ?appeal? the denied claim.
It is especially important to take action when you receive documents from the Virginia Workers? Compensation Commission. An attorney can assist you in figuring out what benefits you should claim and what doctors you can or cannot see.
Workers Compensation claims are challenging as they typically evolve while the claim progresses. Both parties are often involved in the treatment or are carefully watching the treatment. It is extraordinarily helpful to have an attorney on your side to understand and avoid the pitfalls of medical notes that do not explain the connection between the injury and the accident or simply lack the detail that your claim needs.
Workers? Comp Mediation
When a claim is contested or appealed, and if you and your employer are both represented by attorneys, then you can opt to resolve your case through mediation. This is an out-of-court process through which you and your employer discuss your claim in the presence of a neutral third party. If you wish to go through mediation and not rely on a hearing to resolve your claim, our workers? comp attorneys at Lugar Law PC can guide you through this process.
However, going through mediation does not guarantee a resolution. If you and your employer cannot come to a fair agreement regarding your workers? comp claim, then you will still need to participate in a hearing.
The Steps to Appeal a Workers? Comp Denial
The workers? comp appeal process must begin quickly after the Deputy Commissioner?s initial decision on your case. If you receive a decision that you disagree with and believe it is a mistake, talk with an attorney right away. To appeal, you need to follow the administrative process and rules. Otherwise, your right to appeal could be denied, and you could be left with the outcome of the original hearing.
If you disagree with the workers? comp Deputy Commissioner, then within 30 days of the decision, you can file a Request for Reconsideration and/or an appeal. Whether or not this type of request is appropriate under the circumstances depends on the facts of your claim. It may be appropriate if you believe the judge did not review certain evidence or made a factual error when reviewing the evidence. The reconsideration request goes to the Deputy Commissioner directly, who can then review your case and either maintain their position or alter their decision.
You also can appeal to the full Commission within 30 days of the judge issuing the decision, whether or not you filed a Request for Reconsideration. This Request for Review by the Commission needs to offer a specific argument for why you believe the previous decision was made in error. You cannot simply argue that you disagree with the decision, or that it is unfair. Because you need to point to specific errors in the previous decision, it is best to work with an experienced lawyer.
When you are appealing a workers? comp denial to the full Commission, it will review the hearing transcript, any evidence admitted during the hearing, and written statements and briefs submitted by you and your employer. Your written statement to the full Commission should be comprehensive and thorough, which is why we recommend having your workers? compensation attorney draft the statement.
Usually, the full Commission makes a decision after reviewing the hearing transcript, previously-admitted evidence, and written statements. However, there are circumstances under which you or the other party can request oral arguments.
You May Appeal the Full Commission?s Decision
If the full Commission reviews your claim, and you again disagree with the outcome, you may be entitled to appeal to the Court of Appeals of Virginia within 30 days. At this point, you transition away from the administrative process and into the civil court system. The Court of Appeals of VIrginia will follow different rules and processes than the Commission. It is essential that you work with an experienced workers? comp appeals lawyer if you wish to take your claim to court.
If you disagree with the appeals court?s decision, you may be entitled to file an appeal to the Supreme Court of Virginia within 30 days.
When Should You Appeal or Contest Your Claim?
There are very strict deadlines for when you must submit a claim, contest your employer?s decision, or appeal a workers? comp decision. It?s essential to work with an attorney to meet all of these deadlines. In fact, your employer may try to get you to miss these deadlines in order to avoid paying a significant claim.
Do You Have Questions About Appealing a Workers’ Comp Denial? Contact Us Today
At Lugar Law PC, we are prepared to fight for you to receive appropriate benefits under Virginia?s workers? compensation insurance system. Whether you are at the beginning of the workers? comp claim process, or you believe you need to file a workers? compensation appeal, we can help.
We will make sure your appeal or contested claim for benefits is filed in a timely manner and presents a fact-based argument for why there should be a different result. Our attorneys will carefully analyze the facts of your case and develop the strongest argument possible for why you should receive workers? comp benefits.