5 Steps to Properly Appeal When a Denied Workers’ Comp Claim

One of the most frustrating aspects of a workers’ compensation claim is when that claim is denied by the insurance company. There are times when it is denied because you didn’t turn in paperwork on time or the evidence wasn’t compelling enough.

However, there are times when it is denied in order to save money for the insurance company. How can we appeal this denial? Let’s take a look at the first five steps you need to take so you can have a successful appeal.

1. Contact your insurance company.

After your claim is denied, the first thing you can do in your attempt to appeal the decision is to contact the insurance company you are using. It is perfectly okay to come right out and ask them why they denied your claim. The answer could be as simple as you not turning in paperwork on time or it could be that your evidence wasn’t conclusive enough for the company to consider the injury to be covered.

Either option can be fixed when you appeal their decision, which you have a right to in the state of North Carolina. When asking the insurance company about your claim, make sure you are get as much information from them as you can. You can bring this information to your lawyer when you speak with them next.

2. Ask the company to reconsider.

The second step to appealing the claim is to come out and ask the company directly to reconsider the negative response. This is especially true if you have new information surrounding the claim that you feel would change their minds. The fourth step involves compiling that new information along with other information you have for the committee to look over.

3. Gather the paperwork needed for an appeal.

The third step involved in getting a proper appeal for the rejection is to make sure all the paperwork involved in the appeal is filled out properly. It’s always a good idea to make sure the people reviewing the appeal have all the information they need to do so. The paperwork could easily mean the difference between a successful appeal and another rejection in your workers’ compensation case.

4. Make sure to get your evidence in order.

The fourth step in this appeal process is to gather all the evidence you have. If there is new information in your case, make sure this information is among the other evidence for a good case of workers’ comp. It is a good idea during this step and the next one to hire a good attorney to help you during this process. If you have any questions about what you believe to be evidence of workers’ compensation eligibility, the lawyer would be able to answer that question for you.

5. Contact an attorney if you haven’t already.

One of the best things you can do for yourself at this point is to contact an attorney. They will be able to tell you how and why your claim was denied if you aren’t sure. He or she would also be able to help you get witness testimony, gather all your evidence, and stay in contact with the insurance company.

If you missed a deadline that caused the denial, they will be able to file it in the right place by the correct time so you can get it appealed properly. Having the right attorney helping you can mean the difference between a successful appeal and another denial of the claim.

Greenville, NC Workers’ Compensation Lawyer

I’m Brian Ricci, a workers’ compensation lawyer in Greenville, NC. If you or a loved one has sustained an injury at work, please call me at please call me at (252) 777-2222 or 800-387-6406 for free, friendly advice.

I am a longtime member of the Million Dollar Advocates Forum.

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