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How Can I Appeal a Denial of Benefits?

Wilmington Workers’ Compensation Lawyers advise injured workers on how to appeal denied benefits. Many employees across the country are suffering from work-related injuries or illnesses. These injuries or illnesses lead to pain and suffering, loss of wages, and high medical bills. This tends to be a financial burden for employees. Therefore, when an employee receives a denial of benefits, it can negatively impact their finances further. When an employee is in this situation, they may wonder how they can appeal the denial of benefits.

Why You May Receive a Denial

An insurance company may deny benefits for various reasons. For instance, an employee may receive a denial when their injury or sickness is not considered work-related or when they failed to file a claim prior to the deadline. Insurers may believe that the worker is not as severely injured as they claim, was injured outside of work, or was impacted by drugs or alcohol when the injury occurred.

In order to avoid receiving a denial of benefits, it is important to notify an employer of an injury or illness as soon as possible. If the claim is denied, workers have up to two years to file a petition for appeal. When it is time to file an appeal, it is important to contact a lawyer.

How to File an Appeal

Prior to filing for an appeal, an employee should first try to understand why they received a denial of benefits. In many cases, claims are denied due to a simple clerical error. This can be useful, because it allows an employee and insurance companies to try to work things out before going through an official appeals process.

If the employee and insurance company cannot come to an agreement, the next step is to file a Petition to Determine Compensation Due with the Office of Workers’ Compensation. An explanation of the dispute should be included in the petition, ultimately outlining why the worker should have a hearing. Petitioners are encouraged to request a return receipt.

After the petition is filed, the worker will receive a document containing the time and date of the pre-trial. During this phase, a pre-trial memorandum must be filed with the Office of Workers’ Compensation. Ultimately, this memorandum will contain important information, including identifying witnesses, doctor’s reports, and a statement that outlines what benefits the employee is seeking.

The hearing will occur before the Industrial Affairs Board. After both sides present their case, a decision will be given 14 days after the hearing.

If the employee or the insurance company is unhappy with the results of the hearing, each party can file a request for appeal with the county’s superior court within 30 days of the decision. This process may be repeated until the case is presented to the Delaware Supreme Court. However, it should be noted that the Supreme Court’s decision is final.

Wilmington Workers’ Compensation Lawyers at McCann Dillon Jaffe & Lamb, LLC Advocate for Injured Workers’ Rights to Benefits

If you or a loved one is suffering from a work-related injury or illness, you are urged to speak with a qualified Wilmington workers’ compensation lawyer at McCann Dillon Jaffe & Lamb, LLC. Call us at 215-569-8488 or 302-888-1221 for a free consultation or contact us online. We proudly serve clients throughout the states of Pennsylvania, Delaware, and New Jersey, including those in the areas of Philadelphia, Delaware County, Chester County, Wilmington, Dover, Newark, and Middletown, Delaware.