How to Appeal a Massachusetts Workers’ Comp Claim Denial

It is very possible that your workers’ compensation claim will be denied, either partially or wholly. This doesn’t mean that you should give up. Many workers whose claims have been denied have chosen to stop the process and accept that they will receive no compensation for their workplace injuries. Other workers, however, have gone on to successfully appeal this denial and receive the benefits they rightly deserve. The appeals process may seem like a lengthy and confusing process, which is why finding a lawyer you can trust is beneficial.

Steps to Appealing a Workers’ Comp Claim Denial

Once you have received the Insurer’s Notification of Denial – Form 104, or if you have not heard back from the insurance company for 30 or more calendar days since your injury, you may begin the process of filing an appeal.

Step 1: Complete and send off the proper paperwork

The first step in filing an appeal is completing and sending an Employee’s Claim – Form 110 to the Department of Industrial Accidents and to the insurance company. Fill the form out as completely and as accurately as possible to avoid delays. Be sure to attach medical evidence that supports your claim, such as medical bills, your doctor’s chart notes, and other medical reports.

Step 2: Conciliation and Conference

As soon as the Department of Industrial Accidents has received your paperwork, you will be scheduled for conciliation, which is a meeting between you, the insurance company, and a conciliator with the purpose of coming to an agreement. If an agreement is made, the insurance company will begin paying your benefits, but if a resolution cannot be reached, you must attend a conference. A judge will oversee this part of your case and issue a Conference Order.

Step 3: Hearing

Similar to a trial, a hearing includes witness testimony, presented evidence, and cross-examinations. After this hearing, the judge will issue a final decision, which can also be appealed if you are not satisfied with the end result.

Contact a Massachusetts Workers’ Comp Attorney

Appealing a workers’ compensation claim denial is clearly a sophisticated, complex, and lengthy process. If you decided to go along, you will have to be responsible for completing complex paperwork, submitting proper medical evidence, and participating in a court hearing where you will be up against the insurance company’s experienced lawyers. It is important that you speak with a workers’ comp attorney before initiating the appeals process to ensure that everything runs as smoothly as possible. Our lawyers at Powers & Caccavale are dedicated to maximizing your benefits and making sure you get what you deserve. We know the ins and out of the appeals process and will work tirelessly to achieve the best possible outcome. Contact us today for a free case evaluation or call us toll free at (617) 379-0016

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