If you are in Missouri and your workers’ compensation claim is denied, you will want to seek the representation of a knowledgeable and experienced Missouri workers’ comp attorney.
Whether your claim is denied or you are unsatisfied with the benefit amount, you have the right to appeal the determination.
Unfortunately, denials are common.
There are multiple levels to the appeal process. It can be a complex and challenging process.
The first step is meeting with a workers’ compensation lawyer to assess your case and chance at a successful appeal.
Common Reasons for Missouri Workers’ Compensation Denial
You have the right to appeal a denied workers’ comp claim.
If you receive a notice of denial from the Missouri workers’ comp board, it will include a reason for the denial.
Some of the most common reasons why the claim is denied include the following:
- Incomplete or deficient application,
- You are not a covered employee,
- Your employer is not required to have coverage,
- Your injury is not work-related, or
- Your willfulness caused the accident (e.g., intoxication)
This is not an exhaustive list, and there may be multiple reasons your claim is denied.
A workers’ compensation attorney can help you understand the basis for denial and your best way forward.
You may contact the Missouri Workers’ Compensation Dispute Management Unit to request mediation. Mediation is voluntary, and both parties must agree to participate.
The mediator will attempt to facilitate negotiations to see if you can reach an agreement. There will not be a written decision or formal determination.
Conference before an Administrative Law Judge
Another option to facilitate a resolution is a conference with an administrative law judge.
It is not binding and is an informal meeting between the parties in an attempt to resolve the claim without further action.
If neither of these options is successful or available (i.e., one party would not agree to participate), then you move on to the formal appeal process.
Claim for Compensation
Filing a compensation claim is the first formal required level of appeal.
After filing a compensation claim, you can request to once again participate in a pre-hearing conference or mediation as a last attempt to settle the dispute.
There are two types of hearings for your appeal. Which one you request depends on the circumstances.
If your treating doctor determines you are not yet at maximum medical improvement and need additional medical treatment but your employer denies further treatment, you will request a hardship hearing.
A hardship hearing is also appropriate if you seek temporary total disability benefits because you cannot work during your recovery.
A final hearing is appropriate if you have reached maximum medical improvement and your case is ready for final resolution.
There are three types of awards the judge may render:
- A final award.
- A temporary or partial award is usually issued after a hardship hearing to address issues such as medical treatment. The administrative law judge will render a final award at a later time.
- An award on an agreed statement of facts addresses only legal issues because there is no dispute as to the facts.
The type of award rendered in your case will depend on the legal issues presented.
Both a hardship hearing and a final hearing are formal proceedings before an administrative law judge in which your attorney and the insurance company may present their evidence.
Appeal of Administrative Law Judge Decision
If you are still dissatisfied with the administrative law judge’s decision, you may ask the Labor Commission to review the award by applying for review within 20 days.
Finally, an aggrieved party dissatisfied with the commission’s decision may then appeal the award to the Missouri Court of Appeals by filing a notice of appeal with the Labor Commission within 30 days after it issues its award.
The appeal must be filled out on a specific form and include a check for the fee.
Appealing Workers’ Compensation Denial
As you can see, appealing a workers’ compensation denial can be cumbersome and lengthy. The process is time and document-heavy.
There are also precise forms and filing requirements under Missouri law. Being injured at work can be overwhelming, and being denied benefits can only compound your stress and uncertainty.
The workers’ compensation system was made to protect you, and we will help ensure it lives up to its duties. Let us put your mind at ease and assist you through the process.