How do I appeal a denied workers’ comp claim?

Most workers spend more time at their workspace than they do at their house, which is why when a worker becomes injured they expect to be taken care of by their employer. Generally, there are rules in place to protect injured and ill workers if their condition is related to a work accident. This form of protection is k known as workers’ compensation.

Employers are obligated by law to provide workers’ compensation coverage to all their employees in Massachusetts, including pay for reasonable and necessary medical treatment related to a work-related illness or injury and pay for lost wages after the first five days of temporary or permanent disability. Though the system exists to protect workers, employers often up disputing many claims and many others are denied by insurers. So the question then arises-what happens if one’s workers’ compensation claim is denied?

When a claim is denied, the injured worker has the right to file a claim with the Department of Industrial Accidents, and in doing so, a number of legal documents should be completed and attached to the form, including medical bills and medical reports. Once the documents are received by the DIA, they initiate the dispute process by scheduling an informal meeting between the injured person, a conciliator and the insurer’s representative.

The attempt is to make a voluntary agreement between the parties. If an agreement is not made, a conference is held in front of an administrative judge where documents are submitted and both parties make presentations. The Conference order can be appealed in a legal proceeding known as a hearing where sworn testimony is given and witnesses are examined and cross-examined. The decision can further be appealed in front of the Industrial Accidents Reviewing Board, who can ask for more documents or oral arguments. The Massachusetts Court of Appeals hears further appeals from the decision.

As can be seen from the above discussion, the appeal of a denied claim can be a lengthy, time consuming and complicated process where new evidence and arguments can be presented at every stage. In these situations, it may be beneficial to have an experienced attorney advocating for your rights.


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