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Workers' Compensation / Workers’ Compensation / Appeal A Workers’ Compensation Claim

Appealing a Workers’ Compensation Claim in Louisiana and Mississippi

Workers’ compensation is a no-fault system, meaning those injured on the job have a right to file a claim and receive benefits without needing to prove fault. Unfortunately, there are situations in which your claim may get denied. While it could be the result of a simple mistake you made when reporting the incident and filing your claim, there are several other reasons that an employer or their insurance company may attempt to deny your claim or reduce your benefit amount.

Just as you have a right to file an initial workers’ comp claim, you also have a right to file an appeal if you don’t agree with the denial or believe that you did not receive enough. However, filing an appeal can be a long and grueling process. Therefore, it is often best in these situations to work with an experienced workers’ compensation attorney to ensure everything is done correctly and to help relieve the stress and pressure of handling the case on your own.

Reasons For Workers’ Compensation Denials

Most workers assume that if they are injured on the job, their employer’s workers’ compensation insurance will kick in and cover their medical expenses and lost wages. Unfortunately, it doesn’t always work like that. There are several reasons a claim could get denied, but that doesn’t mean you aren’t entitled to benefits. What it does mean, though, is that you may have to fight to get those benefits.

Some of the most common reasons for workers’ compensation claim denials include:

  • Injuries are not severe enough: While workers should file a claim no matter how small the injury, it can still get denied if it doesn’t meet certain standards — for example, if no medical treatment is necessary or if it does not affect your daily life or your ability to return to work.
  • The injury and/or claim was not reported in time: State laws determine how long you have to initially report the incident to your employer as well as how much time you have to then file an official claim. If either of these deadlines is not met, the employer or the insurance may deny your claim.
  • False claims or disputes that the injury was work-related: If you lie about anything relating to your injury, even if it did still happen on the job, your claim could be denied. Additionally, some employers and insurance companies will try to find proof or evidence to say that the injury was not work-related and happened elsewhere.
  • The injury is related to a pre-existing condition: A common basis for denial is that you had a pre-existing condition that is the true source of your ailment. When this isn’t the case, we can help you prove it by producing medical records from before and after the accident and introducing evidence of your lifestyle before the accident. If a workplace injury aggravated a pre-existing condition, you might be entitled to compensation for aggravation of the condition.
  • Delayed medical treatment: After sustaining a workplace injury, the injured worker needs to seek medical attention right away, even if the injury was minor. Lack of medical evidence can lead to a denial. Even if you decide to seek treatment at a later date, it may still be challenging to prove that the injury did not worsen or occur from something else outside of work.
  • Intoxication or willful intent: In some cases, employers may deny a workers’ comp claim if the employee was intoxicated or under the influence of drugs at the time of the injury. This includes the abuse of legally prescribed medications as well as using illegal drugs. Claims can also be denied if the accident was caused by “willful intent.”

How to Appeal a Workers’ Comp Claim in Louisiana and Mississippi

Once you receive your denial letter, you should look it over carefully to ensure that everything reported is correct. If you find any mistakes, you can contact the claims adjuster to have the issue fixed, which may result in a claim approval. However, this does not happen often. Even if a mistake was made, the likelihood of the claim being approved is minimal. Your next steps after receiving a claim denial will be to file an appeal. This is a lengthy process that requires legal representation.

Appealing a Claim in Mississippi

In Mississippi, you must start by filing a petition to controvert with the Mississippi Workers’ Compensation Commission. Be mindful that there are strict time limits for filing. You will have two years from the date of your injury to file. After your petition is received, the Commission will assign you to a workers’ compensation judge and inform your employer’s insurance company that you have filed a petition to dispute the denial.

If an agreement cannot be reached through an informal negotiation with the insurance company, a date will be set for an administrative hearing with a workers’ comp judge. Before the hearing, you will be asked to partake in what is called a “discovery” session, where you and the insurance company will be able to ask questions and exchange information to gather any evidence needed to support your case. This can be a long and complex process that can often take up to a few months to complete.

Once discovery is completed and the hearing date is set, you will be asked to submit a statement outlining your issues and any evidence collected to back up your dispute. After you have made your case in court, the judge will review the evidence and statements. Their decision will be mailed out following the hearing.

Further Appeals:

If the judge makes a decision that you do not agree with, you may then appeal to the Full Commission by filing a petition within 20 days of the workers’ comp judge’s order. You can request another hearing if you desire, but typically the Full Commission will make their decision without the need for another hearing. Once a decision is made, the Commission will mail their decision to you and the insurance company.

If you are still not happy with the decision, you may further appeal through the state court system and must do so within 30 days. All documents and records of your case will then be mailed to the Mississippi Supreme Court.

Appealing a Claim in Louisiana

If you want to file an appeal in Louisiana, you will need to file a Form 1008 Disputed Claim for Compensation with the Office of Workers’ Compensation (OWC). This form must be filed within one year of your injury. After the OWC receives your form they will review and assign your case to your local district office and then schedule a hearing.

Both parties will have the opportunity to partake in a mediation where you may attempt to come to an agreement. If an agreement cannot be made, you will move on to the hearing. Similar to the process in Mississippi, the hearing process can take a long time and involves questioning witnesses and gathering other information to collect as much evidence as possible for when you present your case in court. Following the hearing, a judge will make a decision that is binding unless another appeal is made.

Further Appeals:

Unlike in Mississippi, if you disagree with the judge’s ruling, you will skip the second administrative review process and go straight to filing an appeal with the Circuit Court of Appeal. You must file the necessary documents within 30 days of the judge’s decision.

Keep in mind that, while you have every right to an appeal, the process can take a long time, no matter which state you live in. It can be complicated to keep everything straight and know what steps you need to take and what paperwork you need to file during this time. For this reason, you must seek out an experienced attorney to handle the legalities of your claim appeal. Working with an experienced attorney ensures that you are organized and prepared to answer any questions put forth in a manner that will win you your deserved benefits.

Contact An Experienced Louisiana and Mississippi Workers’ Compensation Attorney

The process of filing for workers’ compensation can be tricky, and it’s easy for mistakes to be made. Additionally, you may find yourself up against an insurance company trying to deny your claim or reduce the benefit amount. Our dedicated workers’ comp lawyers can help you at every stage of the workers’ compensation process in Mississippi and Louisiana to ensure you get the compensation you deserve.

For help with a Louisiana or Mississippi workers’ compensation claim, contact the workers’ compensation lawyers at Lunsford, Baskin, & Priebe, PLLC, for a free consultation.

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