Appealing a Workers’ Compensation Claim in Louisiana
If your workers’ compensation claim gets denied, you have a right to file an appeal, especially if you think the denial is the result of an error or you believe your employer and their insurance company are unfairly denying you benefits or the full amount you deserve. There are various reasons why a claim might get denied, but often it is because insurance companies don’t believe they owe you benefits.
However, even if you are owed benefits, filing an appeal is more complicated than filing an initial claim. It is a long and grueling process, and if anything is done incorrectly, it can result in another denial. If your claim gets denied, it’s in your best interest to work with an attorney who can help you through the process to ensure the best possible results.
The Louisiana workers’ compensation lawyers at Lunsford, Baskin, & Priebe, PLLC help injured workers get the benefits they are entitled to after a workplace injury, including helping with appeals. Our lawyers represent ironworkers, construction workers, truck drivers, general laborers, firefighters, and first responders who have been injured on the job. Learn more about appealing a claim denial below, and contact Lunsford, Baskin, & Priebe, PLLC if you need help.
Who is Eligible for Workers’ Compensation in Louisiana?
In the state of Louisiana, all employers with one or more employees are required to carry workers’ compensation insurance. Both full-time and part-time employees are eligible as long as they earn a minimum of $3,000 annually. If this applies to you and you received a denial, there may have been a mistake made when the claim was initially filed. However, it is also possible that your employer or their insurance does not believe that your injury warrants benefits. In either situation, you should file an appeal if you disagree.
There are also some types of workers who are not eligible for benefits, including:
- Undocumented aliens
- Domestic employees
- Licensed real estate agents
- Directors of certain non-profit organizations
- Airplane crews while performing dusting and spraying procedures
- Workers performing mining-related services
Reasons For Workers’ Compensation Denials
Receiving a workers’ compensation claim denial is not uncommon. If you are denied benefits, it does not necessarily mean that you are not eligible. There are many reasons why your claim might have been denied. It’s important to understand why claim denials happen to avoid making mistakes when you file.
Common reasons your claim may have been denied include:
- Minor injuries: If your injury is so minor that it does not require medical treatment or time off of work, your claim will likely get denied. An injury must meet certain criteria for a worker to be eligible for benefits.
- Failure to report in time: You have 30 days to report a workplace incident and file a claim in Louisiana. If you reported your injury after 30 days, this might be why you received a denial.
- False claims: Lying about the accident or how the injury happened can also result in a denial. Even if the injury occurred in the workplace, if you exaggerate what happened or make any false statements, your claim will likely get denied. Employers and insurance companies may also make false claims that your injury did not happen while working on the job.
- Pre-existing conditions: If you have a pre-existing condition, insurance companies may try to use your previous medical history against you to deny your claim. However, even if you are more susceptible to injury because of a pre-existing condition, you still have a right to claim benefits if the injury happened due to work performed on the job.
- Lack of medical evidence: If you did not go to the emergency room or see your doctor for treatment of your injury, you might receive a denial. This is because you will need medical evidence to support your claim to prove that your injury is substantial enough to warrant benefits.
- Intoxication: If you were intoxicated or under the influence of drugs at the time of the incident, your employer might use this against you to deny your claim. Though workers’ compensation is a no-fault benefit, it can be difficult to argue your case if you were under the influence of alcohol or drugs.
How to Appeal a Workers’ Comp Claim in Louisiana
If your claim gets denied, you should look over the documents carefully to ensure that everything was correctly reported. If you find any mistakes, such as a misspelling or a wrong date, you can contact the claims adjuster to have the issue fixed. Once the error has been corrected, your benefits may then be approved. However, if you still receive a denial, your next step will be to file an appeal.
If you want to file an appeal in Louisiana, you will need to file a Disputed Claim for Compensation with the Office of Workers’ Compensation (OWC) when there is a disagreement over temporary or permanent disability benefits. This form will need to be mailed to both your employer and the OWC, and it must be filed within one year of your injury. If your dispute is over medical benefits, you will need to file a different form—a Disputed Claim for Medical Treatment—and the same timeline applies. 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. 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. If you disagree with the judge’s ruling, you will then need to file an appeal with the Circuit Court of Appeal. You must file the necessary documents within 30 days of the judge’s decision.
Though it is your right to follow through on the appeals process, it’s important to note that it can take a long time. You will need to stay on top of times and dates and ensure everything is filed correctly. In these situations, working with an attorney can be extremely helpful. An experienced lawyer will help you stay organized and ensure everything is done as quickly and efficiently as possible to get your benefits approved.
Contact An Experienced Louisiana Workers’ Compensation Attorney
Dealing with claim denials and appeals can be a frustrating and complicated process. Keeping everything straight and knowing what steps you need to take is essential if you want to properly appeal your workers’ compensation claim denial. Our team of dedicated and hardworking attorneys can help you along the way to ensure the best possible outcome.
For help with a Louisiana workers’ compensation claim, contact the workers’ compensation lawyers at Lunsford, Baskin, & Priebe, PLLC, for a free consultation.