Were You Denied Benefits? Our Boston Workers’ Comp Attorneys Can Explain the Appeals Process

If you suffered a work-related injury or illness on the job and your employer’s insurance company denied your claim, you may have the option to appeal.

At Jim Glaser Law, we connect injured workers who were denied benefits with a Boston workers’ comp attorney who is knowledgeable in this complex area of the law. Claims are denied for various reasons. However, a denial doesn’t always mean that you’re not entitled to benefits.

Our law office is here to help you understand your legal options and whether you can appeal your denied claim.

Most Common Reasons Claims Are Denied

It’s not unusual for workers’ compensation claims to be denied. In some cases, claims are denied due to simple mistakes.

The most common reasons for denied workers’ comp claims include:

  • Missed Deadlines – To receive benefits, it’s important that you report your injury to your employer immediately. If you delay in informing your employer, it can result in a denied claim.
  • Your Condition Doesn’t Meet State Requirements – Every state has its own laws pertaining to workers’ comp benefits. Some claims are denied due to state-specific restrictions or because the worker’s injury wasn’t severe enough.
  • There Is a Dispute Over Whether Your Injury or Illness Is Work-Related – In some cases, your employer’s insurance company may say your injury or illness was not directly caused by your job, leading to a denied claim.
  • Your Claim Was Filed After Leaving Your Job- Typically, claims will be denied if they were filed after the employee quit, was fired, or laid off. However, there are certain situations where you may still be able to receive workers’ comp benefits after leaving your job. An attorney can evaluate your claim and inform you whether or not you are qualified for benefits.

What Do You Need for the Appeals Process?

If your claim for workers’ compensation is denied, you can file an appeal with the Department of Industrial Accidents (DIA). According to Mass.gov, you will need to file a Form 110- Employee Claim that includes the following information:

  • The date of your injury
  • The first calendar day of work missed
  • The fifth calendar day of work missed
  • Your employer’s workers’ compensation insurance carrier
  • The body parts affected and the types of injuries
  • The types of benefits you’re looking to obtain
  • How long you may be out of work, if known
  • Your current treating doctor

Also, you’re required to include a copy of at least one of the items below and bring the rest to the first stage of your appeal:

  • Unpaid medical bills
  • Medical reports
  • Witness names
  • Witness statements
  • Reports that support how the accident occurred

The 5 Levels of Appeals

Keep in mind that filing an appeal can be complicated without strong legal representation. For this reason, our team highly recommends that you consult an experienced lawyer for help.

Here are the five levels of the appeals process in Massachusetts:

1.Conciliation

Here, you will have an informal meeting with both the insurer and the DIA. During this phase, a conciliator will try and help you and the insurance company reach an agreement. However, if a voluntary agreement cannot be made, then your claim may move to the next level.

2. Judicial Conference

If the first step fails, your claim may be heard by an administrative judge who will hold a conference between you and the insurer to evaluate the details of your work-related injury.

Within seven days of the conference, the judge will issue a written order that explains their decision regarding your claim.

3. Hearing

If the judge’s decision isn’t in your favor, you may have the option to further appeal by requesting a full evidentiary hearing. Keep in mind that you have 14 days after the judge’s initial decision to file for a hearing.

During this stage, you can submit evidence and have witnesses speak on your behalf.

 4. DIA Review 

If you’re not pleased with the decision at the hearing level, you may have the opportunity to appeal within 30 days to the DIA’s Reviewing Board. The board will then review the hearing transcript and make a decision as to whether or not your denial should be reversed.

5. Court Appeals

 Any additional appeals that surpass the Review Board will go to the Massachusetts Appeals Court. In some cases, a claim could reach the Massachusetts Supreme Court.

Need Help Appealing Your Denied Claim? Call Us!

Filing an appeal for workers’ compensation benefits is tedious and time-consuming. At Jim Glaser Law, we are dedicated to helping injured workers receive the benefits they deserve. If your workers’ comp claim was denied, you don’t have to navigate the appeals process alone.

An experienced Boston workers’ comp attorney can help you gather all of the necessary paperwork and fight on your behalf. Call our law office at 781-689-2277 or fill out our online form to request a free case evaluation. We’re here to help you!