What To Do If Your Workers’ Comp Claim Is Denied

red grunge rubber stamp print with words CLAIM DENIED - workers comp claim denied concept

A workplace injury can result in significant financial loss. Fortunately, Workers’ Compensation benefits may relieve some of the economic burden you are facing by covering your medical treatment and lost wages. If your workers’ comp claim is denied by the Washington State Department of Labor & Industries (L&I), you might be wondering what to do next. In such cases, you may file a protest or appeal to overturn L&I’s initial determination to get the claim allowed.

Reasons Your Workers’ Comp Claim Might Be Denied

There are many reasons a Workers’ Compensation claim may be denied. For instance, you may not have filed your claim on time, or your injury might not be work-related. Other common reasons a Workers’ Comp claim might be denied in Washington can include the following:

  • Incomplete paperwork
  • Your injury is linked to a pre-existing condition
  • The accident occurred while going to or from work, or during a break
  • The injury arose from horseplay
  • Incomplete information from medical providers

A claim can also be denied due to an error by L&I. This is why it is crucial to have an experienced Workers’ Compensation attorney who can review the details of the denial and work to ensure you receive the benefits you deserve.

What Are Your Options if Your Workers’ Comp Claim is Denied?

A Workers’ Compensation claim denial may seem daunting. However, you may still have options to obtain L&I benefits. In fact, there are two avenues you can pursue if your Workers’ Compensation claim is denied in Washington. You can either file a protest to L&I’s decision or appeal the decision to the Board of Industrial Insurance Appeals. While a protest is less formal and sent to your claims manager, an appeal is formal and submitted to the Board of Industrial Insurance Appeals.

It is essential to note the deadline to protest or appeal the denial of your claim. Typically, this is 60 days from receipt of the L&I order. If you do not challenge the decision within this time frame, you are waiving your right to do so — and the decision rendered would become binding.

Filing a Protest to L&I’s Decision

A protest is also known as a request for reconsideration. Once the letter has been sent to L&I, it will be reviewed. If you can provide strong supporting evidence for your position, L&I may reverse its decision. Otherwise, it will issue a new order upholding its previous decision. In the event your protest is unsuccessful and you disagree with the new decision, you may appeal to the Board of Industrial Insurance Appeals (BIIA).

Appealing an L&I Decision

An appeal to the Washington Board of Industrial Insurance Appeals can either be filed after a protest or immediately following the initial determination. The appeal must be in writing and list every issue in the decision being appealed and the reasons why you disagree with the decision.

Usually, after an appeal is filed, a mediation conference will be held. This allows an opportunity for you, the Department of Labor & Industries, and your employer to resolve the dispute informally. If a settlement is not reached at mediation, a hearing before an industrial appeals judge may be necessary. These hearings are similar to a trial in court — Both sides can present evidence, documents, and witness testimony.

Contact an Experienced Washington Workers’ Compensation Attorney

Protesting or appealing a Workers’ Compensation denial can be complex. It is essential to have a skilled attorney by your side who can guide you through the process and take your claim through an appeal. The Bellingham Workers’ Compensation attorneys at Robinson & Kole provide dedicated representation to injured workers throughout Washington State and strive to secure the best possible outcome in each case. We welcome you to contact us for a free consultation by calling 800.640.5616 or by using our online contact form. Se habla Español.