Workers’ Compensation Denial Lawyers

If you were injured on the job and filed a workers’ compensation claim, you may feel disappointed, even shocked, to find a denial letter in the mail. Likewise, if you find the State has closed your claim early, or denied your application to reopen your claim, you’re most likely now seeking legal recourse. Our firm can help. Contact the skilled Central Washington workers’ compensation denial lawyers here at Calbom & Schwab Law Group, PLLC for comprehensive guidance today.

Why Was My Workers’ Compensation Claim Denied?

There are several reasons why a workers’ compensation claim may be denied in Washington State, and, rather importantly, many of these denials have more to do with technical issues, missing information, or disputes over evidence than with a clear finding that you were not actually injured at work. Some of the more common reasons include the following:

• You did not report your injury within the required timeframe: In Washington, workplace injuries must be reported within certain deadlines, and if there is a delay, it may raise questions about when and where the injury actually occurred.
• There is a dispute over whether your injury is work-related: In some cases, L&I or a self-insured employer may argue that the injury happened outside of work, or that it is unrelated to your job duties altogether.
• You have a pre-existing condition affecting the same body part: If you previously injured the same area of your body, the claim may be denied on the basis that your current condition is not tied to your employment.
• There is not enough medical evidence connecting your injury to your job: Medical records play a central role in these cases, and if your treating provider does not clearly link your condition to your work activities, the claim may not be approved.
• Paperwork was incomplete or deadlines were missed: Even relatively small administrative issues, such as missing forms or incomplete filings, can result in a denial.
• Your employer is disputing your claim: Employers sometimes challenge claims, particularly where there are inconsistencies in how the injury was reported.
• An independent medical exam did not support your claim: If an IME doctor concludes that your injury is not work-related, or is less severe than reported, that opinion may be used to deny benefits.
• There are allegations involving misconduct or intoxication: If there is evidence suggesting that drugs, alcohol, or intentional actions contributed to the injury, benefits may be denied under Washington law.

What if My Workers’ Compensation Claim is Denied in Washington State?

If your claim has been denied, you are not without options, even though it may feel that way at first. Washington State gives injured workers the ability to challenge these decisions, though the path you take will depend on the specifics of your case and how the denial was issued.

Generally speaking, you have two primary options. First, you can file what is known as a protest, which is essentially an informal request asking the Department of Labor & Industries to take another look at its decision. This option is often used when there has been a misunderstanding, when additional medical evidence is available, or when something may have been overlooked during the initial review. Because the protest process stays within L&I, it can sometimes move more quickly, though you are still asking the same agency to reconsider its own determination.

Second, you can file a formal appeal with the Board of Industrial Insurance Appeals. This takes the matter out of L&I’s hands and places it before an independent body, where an industrial appeals judge will review the evidence and, in many cases, hear testimony. This process is more formal, and it may involve hearings, legal arguments, and additional documentation, though it also provides a different level of review than a protest.

Timing is critical here, and this is something that cannot be overstated. In most cases, you will have 60 days from the date you receive the denial order to file either a protest or an appeal, and if that deadline passes, you may lose your right to challenge the decision altogether. That is why it is important to review the order carefully and act as soon as possible.

The Process

Understanding how the protest and appeal processes work can make a significant difference, especially when you are trying to decide what to do next. While every case is different, the general process tends to follow a fairly predictable sequence.

1. Carefully review the denial order: To start, you should read the order in full and make sure you understand exactly why the claim was denied, as the reasoning will guide everything that follows.
2. Decide whether to file a protest or a formal appeal: At this stage, you will need to determine whether the issue can likely be resolved by submitting additional information through a protest, or whether it requires a more formal challenge through the appeals process.
3. Submit your protest or appeal within the deadline: Deadlines are strict, and you will generally have 60 days to act, so it is important to make sure your filing is completed and submitted on time.
4. Gather and organize your supporting evidence: This may include updated medical records, written opinions from your treating providers, incident reports, and any other documentation that helps establish that your injury is work-related.
5. Participate in the review or hearing process: If you filed a protest, L&I will reconsider the claim and may issue a new order, whereas an appeal will proceed to the Board, where hearings may be scheduled and evidence will be formally reviewed.
6. Receive a written decision: After reviewing the evidence, the agency or the Board will issue a decision, which may approve your claim, modify it, or uphold the denial.
7. Evaluate whether further action is necessary: If the outcome is still not favorable, additional appeals may be available, though these steps can become increasingly complex.

What If the State Has Closed Your Claim?

If you have been injured on the job or have contracted an illness related to your work, you may have already received benefits based on your workers’ compensation claim. If your injury or illness is not permanent, at some point, the Washington State Department of Labor and Industry (L&I) will decide to close your claim. What happens if your injury or illness is still ongoing or gets worse after L&I closes the claim? Do you have recourse to reopen your claim?

Yes, you do. You may file to reopen a claim if you believe your claim has been closed prematurely or if your situation worsens—but be prepared; L&I may deny your application to reopen your claim if they feel you have no further basis for benefits.

What You Need to Know Before Reopening Your Claim

There are two situations in which you may need to reopen your claim:

• You believe your claim was closed prematurely. If your job-related injury has not healed or your job-related illness is ongoing, and your case has been closed by the State, you may be able to reopen your case. You have 60 days from the time your claim was closed in which to protest or to appeal the closure of your claim.
• Your condition worsens. If, after your case was closed, your job-related injury or illness worsens, you may file to reopen your case with L&I. You have a lifetime right to file for reopening under these circumstances. In most instances, you have seven (7) years to file for reopening under these circumstances. You will need to have a doctor who, in his or her medical opinion, believes that your job-related condition is worse since the date your claim was closed.

If you and a doctor agree that your condition has worsened, you must demonstrate that the condition is related to your on-the-job illness or injury. Your worsened condition does not have to be the exact same injury or illness; it only needs to be related to it.

For example, if you injured your hip in an accident on the job, and that injury later led to problems with your back, you may file to reopen on the basis of your current back injury. In another example, if the stress of the injury or illness has affected your mental health, you may also have a basis for filing to reopen. Your doctor must be able to establish clearly that your condition has been aggravated by your initial claim and that any changes are related to the original injury or illness.

What Happens When Your Application to Reopen Is Denied?

The Washington State Department of Labor & Industry may deny your application to reopen your claim. How do you proceed at that point? Do you have a way to recover benefits for your ongoing or worsened illness or injury?

You, your doctor, or your employer all have the right to protest or appeal L&I’s ruling. Calbom & Schwab are experts at getting your claim reopened based on the appeal of any of these parties. We will work with you and your doctor to establish that your injury or illness has been aggravated and that you may be entitled to further benefits under the law.

You must file a protest or appeal the ruling within 60 days of the denial order from L&I, so contact our workers’ compensation denial lawyers right away to protect your rights.

Contact Our Central Washington Workers’ Compensation Denial Lawyers

If you’re facing a workers’ compensation denial, our dedicated team of lawyers is here to help. Contact Calbom & Schwab Law Group, PLLC for a free and confidential consultation today.