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What to do if your workers’ compensation claim is denied

On Behalf of | May 8, 2024 | Workers' Compensation

Receiving a denial for a workers’ compensation claim can be frustrating, especially when you are dealing with injuries and financial worries. However, in Massachusetts, you have the right to appeal this decision, and it is important to understand the steps necessary to do so.

1. Understand the reasons for denial.

The first step is to understand why your claim was denied. Common reasons include claims that the injury is not work-related, missing documentation, or filing past the deadline. Your denial letter should specify the reason, which is crucial for planning your next steps.

2. File for an appeal.

In Massachusetts, you must file an appeal within four months from the date the insurer issued the denial. Start by submitting a Form 110 – Employee’s Claim to the Department of Industrial Accidents. This form will initiate the legal process where you can argue your case.

3. Prepare for the conciliation.

Your appeal will begin with a conciliation, which is an informal meeting between you, your attorney, a representative from your employer’s insurance company, and a conciliator from the Department of Industrial Accidents. It’s important to gather all medical records, witness statements, and any other evidence that supports your claim of injury and its relation to your work.

4. Proceed to the conference.

If your claim isn’t resolved at conciliation, the next step is a conference before an administrative judge. This is more formal than conciliation. You might need to present more detailed evidence and possibly expert testimony about your injuries and how they affect your work.

5. Understand further appeals.

Should the judge decide against you at the conference, you can further appeal to the Reviewing Board and, if necessary, to the Massachusetts Court of Appeals. Each step requires more detailed preparation and understanding of legal arguments.

Getting your workers’ compensation claim initially denied doesn’t mean the end of the road. Understanding your rights and the appeals process in Massachusetts can help you effectively challenge a denial and seek the benefits you deserve.

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