Best Practices for a Workman’s Comp Appeal Procedure

Best Practices for a Workman’s Comp Appeal Procedure

It can be upsetting to learn that your worker’s compensation claim has been denied by your company insurance. In Minnesota the worker’s compensation laws give you up to 3 years to appeal the denial — but you aren’t guaranteed to get the decision overturned.

Navigating these waters alone is harder than it may seem. Consider working with an experienced worker’s compensation lawyer to have your best chance of winning your appeal.

At Sundquist Law Firm, not only can we help you file a claim, but we can also assist you in every part of the appeal process. If you’ve suffered an occupational injury and your employer’s insurance company denied your claim, don’t worry. 

In this article we’re going to help you understand your workers compensation appeal and help you break through the legal jargon. 

Understand the Denial

When the insurer denies your worker’s compensation claim, they are required to provide a reason. Usually, this boils down to them questioning that the harm you sustained was related to your work. They may also allege that your injuries resulted from your negligence rather than any flaws in your employer’s safety training and programs.

Their reasoning comes in the form of clear-language explanation as well as the legal basis for their denial. Keep all of the documentation and show it all to a workers’ compensation lawyer. They will make sure you understand everything it contains. 

You should also contact the insurance company and ask them if they can provide specifics about why they rejected your claim. Sometimes they may use technicalities in how you filed to support their denial. For example, an incomplete claim with missing documentation often leads to a denial regardless of circumstances.

Beginning the Appeal

Once you and your injury lawyer have gone over your denial and contacted the insurer, you’re ready to begin the appeal process. The first step is to complete the Employee’s Claim Petition. This form outlines the details of your claim, including your injury, where and how it happened, medical treatments or procedures you’ve received, and the benefits you are claiming. 

In addition to completing the Employee’s Claim Petition, you’ll need to collect any medical reports relevant to your workplace injury. Your lawyer can help you gather these for your report. To fully support your appeal, it’s vital to be as thorough as possible with this process. 

You need to file the combined petition and medical reports with the Minnesota Department of Labor and Industry (MDLI). The MDLI website provides claimants with the necessary forms online. You can find the details for filing your paperwork online or through the mail here.

Copies of the form need to be sent to your employer and their insurer as well. Keep in mind that the law limits how long you have to file your petition. Currently, you must file within three years of your employer reporting the incident. It’s best to file it sooner than later, but if your injury makes that difficult, your lawyer can assist you in completing the Petition. 

The MDLI Conference 

When the MDLI receives your petition, if your claim is about treatments and therapy for your injury, they’ll schedule what’s called an administrative conference. The conference is an opportunity for all the parties involved to make their case regarding the appeal.

MDLI will assign a mediator to your case. The mediator will hear from you, your employer, and their insurer. Everyone will have the opportunity to present evidence and legal arguments in favor of or against the initial claim and appeal.

The mediator’s job is to encourage everyone to reach an agreement with the appeal. However, if you and the insurance company can’t reach an agreement, it falls on the mediator to make a judgment themselves. For this reason, we urge you to gather as much evidence as you can with your Petition.

However, if the MDLI considers the matter clear-cut, they may issue an order without mediation.

If your case isn’t so simple, MDLI may direct it to the Office of Administrative Hearing (OAH). The OAH will use a workers’ compensation judge in place of a mediator. Both sides will still make their cases and present evidence before the judge makes a ruling.

In any case, the final ruling will hopefully be in your favor. However, there is always a chance that you’ll lose, and the judge will deny your appeal. At this point, many claimants will give up their case, but it doesn’t have to be the end.

Challenging A Denial

When a judge makes their ruling regarding workers’ compensation claims and appeals, they include a time frame for you to challenge their decision. Doing this isn’t a second chance to make your argument again. Instead, you must file your challenge with Minnesota’s Workers’ Compensation Court of Appeals. 

When you take your challenge to the court of appeals, they’ll already have the evidence you presented to the OAH judge. At this point, you and your attorney need to make your argument that the judge’s ruling was somehow mistaken. Our legal team will analyze the previous decision to find everything that may support your challenge.

If the appeals court sides with the judge, you can appeal one more time and take your challenge to Minnesota Supreme Court. As the highest court in the state, they may rule differently and award you workers’ compensation. However, you are only given sixty days from the time of the appeal court’s ruling to appeal to the state supreme court.

What Makes A Strong Appeal?

Regardless of how many challenges your appeal goes through, its foundation needs to be solid documentation. When it comes to work-related injuries, there’s no such thing as being over-prepared. Your employer’s insurer can potentially use any gaps in the records you present to undermine your entire claim.

Our lawyers will go through every avenue we can to acquire the information needed to present a strong case. Getting medical records is only part of this. We also focus on getting your employer’s health and safety records (including records of your accident). After the first appeal, you won’t have an opportunity to present new evidence, so it’s important to prepare to the fullest extent.

Work With Our Experienced Lawyers

Minnesotan construction workers are tough and dedicated, but that alone doesn’t protect them from workplace injury. The UCWCP is an excellent alternative to the state offered reporting program and sees many of these injuries on a regular basis. 

Even though workplace accidents are common, that doesn’t mean you have less to lose. Letting these incidents go without seeking workers comp or letting a denial stop you in your tracks can result in lost wages, medical debt, and even being unlawfully let go because of your injury. Don’t let that happen to you!

Hiring a workers compensation lawyer is the best bet for navigating the hard after effects and guaranteeing your financial, physical, and mental well being. 

At Sundquist Law Firm, we specialize in getting Minnesota construction workers the justice they deserve. If you’ve been injured on the job, contact Sundquist Law Firm today and get compensated for your injuries.