Appealing A Denied Connecticut Workers’ Compensation Claim

Having one’s workers’ compensation claim denied can be a jarring experience; you are in need of medical care, and to be denied it is a frightening thing. There are many reasons that claims may be denied, and many of them are insurmountable – but with the right legal help, you can file an appeal that may win the day. There is a specific process through which a denied employee can try to convince the relevant authorities that their claim should be granted.

Most workers’ compensation claims are approved, but if yours has been denied, it is likely for one of several reasons. Examples include (but are not limited to):

• Your employer (or their insurer) does not believe your injury was work-related;
• You waited too long to file (there is a 1-year statute of limitations on filing claims for work injuries, and 3 years on claims for occupational disease);
• You allegedly caused your own injury;
• Mistakes in the relevant paperwork; and
• You are classified as an independent contractor and thus not eligible for workers’ compensation benefits.

Be aware that some of these issues are not “fixable” – rather, your application for benefits should be resubmitted. However, some of these alleged problems can be fodder for an appeal – for example, if your employer alleges that you caused your own injury, you may prevail on appeal if you can establish that you did not. To begin the appeal process, you must request an informal hearing, which is essentially a mediation between you and your employer to see if something can be worked out. Quite a few of these cases are settled here, particularly if the dispute has been in good faith. After all, most employers are not looking to deliberately cause harm or pain to their employees.

If this is unsuccessful, the next step is a formal hearing, at which you may present your Petition for Benefits to a judge from the Office of the Judges of Compensation Claims (OJCC). A formal hearing is somewhat like a court trial, but subject to different rules of procedure and rules surrounding the potential outcome. This is where the assistance of an experienced attorney may come in handy – they are familiar with what the judge may be looking for or what may need explanation.

Be advised that whether you prevail at the OJCC or not, you or your employer may appeal the decision for up to 20 days after it is received. This appeal would go to the review board of the Workers’ Compensation Commission – however, this appeal is only for new evidence, and will only be granted under certain circumstances. The standard of review is quite high, and the odds may not be in your favor.

Contact A Connecticut Workers’ Compensation Attorney

If a person is injured on the job, most of the time their claim for medical treatment will be granted. However, if it is not, it is important to be aware that you do have options to try and overturn a denial. Your and your family’s financial future is too important to simply accept an insurer’s refusal – contacting a Stratford workers’ compensation attorney from the Morizio Law Firm can make all the difference in how to proceed after the denial. Call us today for a free consultation.

Sources:
cga.ct.gov/current/PUB/chap_568.htm#sec_31-294c
portal.ct.gov/WCC/Workers-Compensation-Commission/Dispute-Resolution