How Do I Appeal A Denied Workers’ Compensation Claim?

The denial of a claim is called a denial of “compensability.” The only recourse for a denial is to bring the case in front of an administrative law judge. Insurance carriers often deny claims hoping the injured worker give up, but the better option is to seek a free consultation from an attorney and file an application for a hearing.

Another type of denial will occur after a workers’ compensation claim has initially been accepted. For example, if an insurance carrier agrees to pay for some of the medical treatment needed but denies a recommended surgical procedure then again, the worker must file an application for a hearing and go in front of an administrative law judge. The insurance carrier would likely argue that the additional recommended medical treatment is for a condition unrelated to the worker’s injury, and at that point, it would be up to the judge to determine whether the procedure should be covered.

Unfortunately, many people get frustrated and try to use their own personal health insurance to receive treatment. Some adjusters basically make it their mission to scare away injured workers but it’s important for people to know that there are options and attorneys who can help them obtain the compensation they need and deserve.

If An Appeal Is Successful, Will The Injured Party Be Compensated?

If, for example, an injured worker sustains an injury and loses time from work on February 1^st, the insurance company denies the claim on February 10^th, and the hearing for the denial of those benefits happens in May or June, then success means that the injured worker would be given retroactive compensation for lost wages back to February 1st.

What Happens If I Am Not Successful At The Appeals Level? Do I Have Other Options?

If an issue is denied by a judge, an injured worker has the right to file a petition for review. The appeal would then go to the Industrial Claim Appeals Panel. If the Industrial Claim Appeals Office (ICAO) also denies the claim, then the injured worker has the right to appeal to the Court of Appeals. Depending on the determination in the Court of Appeals, the appeal process might proceed to the Supreme Court, but it is generally very difficult to have the Supreme Court accept an appeal for review.

How Are Workers’ Compensation Benefits Calculated In Colorado?

There are different types of workers’ compensation benefits in Colorado, the first of which is temporary disability benefits, or wage replacement benefits. These benefits provide two-thirds of the worker’s average weekly wage which is determined by looking at the injured employee’s earnings over a period of time leading up to the date of injury. If a worker’s earnings were higher over the year preceding the injury, then they could certainly request that the judge consider their yearly earnings instead of six weeks or six months of earnings prior to the date of injury.

Different rules may apply depending on the worker’s earning schedule. For example, if a worker’s income was commission-based or the worker regularly earned overtime wages, then that would be taken into consideration. Temporary disability benefits are not taxable, which means the worker will not have to pay income taxes on the temporary disability benefits they receive. There is a maximum weekly amount of temporary disability benefits every year and the weekly amount changes on July 1^st of each year.

The second type of workers’ compensation benefit is called a permanent disability benefit. If a person is capable of returning to any employment at the end of the case permanent partial disability benefits are paid. This is the payment to the employee for any permanent loss to the employee’s body after the injury is done healing. The way in which permanent disability benefits are calculated will depend on the body part where the injury was sustained.

For more information on Appealing A Denial Of Workers’ Comp Benefits, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (303) 420-8080 today.