What Can I Do if My Workers’ Compensation Claim Gets Denied?

An old proverb tells us: “If at first you don’t succeed, try, try again.”  This about sums up what claimants can do if they’ve filed a workers’ compensation claim with the Washington State Department of Labor & Industries (L&I) and the claim gets denied.  The “try again” part means workers have the right to appeal their workers’ compensation denial.

The following takes a closer look at the appeal process.  Please note that this is a big picture as to how the appeal process works for workers’ compensation claims that are denied in Washington.  The nature of specific cases always varies depending on the specific facts involved.  As always, Phillips Law Firm stands ready to address your specific needs and concerns.  Please contact one of our experienced workers’ compensation attorneys today to get your specific questions answered.

Protest and Request for Reconsideration

If your workers’ compensation claim gets denied from L&I, the first way to appeal the decision is to file a “Protest and Request for Reconsideration” with L&I.  There is no exact form for this protest and request.  Rather, denied claimants simply write a letter to the adjudicator listed on the denial order in dispute.  Within the letter, claimants provide the reasons as to why they disagree with the reasoning behind the decision to deny benefits.

Once this document is sent, an L&I employee will review the claimant’s original claim, denial order, and the protest and request information.  L&I has 60 days to review this information and make a determination as to whether it will affirm the original order of denial, reverse it or modify it. If a claimant is dissatisfied with this determination, he can then file an appeal with the Board of Industrial Insurance Appeals (Board of IIA).

Appealing to the Board of IIA

Filing an appeal with the Board of IIA involves filing a specific appeals document.  This document can be found online at: www.biia.wa.gov.  The document is free to file, but denied claimants must bear their own litigation expenses if a case proceeds to a hearing.

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After an appeal is filed with the Board of IIA, the Board typically holds a mediation conference.  If a claimant and his employer are unable to resolve matters at the conference, the case will be sent to a hearing.  A hearing at the Board of IIA is much like a trial in court.  By this, we mean a claimant and his employer have the right to present evidence (primarily through witness testimony) to help prove their respective cases.  A judge presiding over the hearing will then issue a Proposed Decision and Order that determines the ultimate ruling in the hearing.

Appealing a Proposed Decision and Order

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If a claimant is dissatisfied with a judge’s Proposed Decision and Order, the claimant then has another appeal at his mercy.  This appeal is known as a Petition for Review.  A Petition for Review is a legal document in which a claimant states the specific reasons as to why he believes the Proposed Decision and Order was inaccurate.  The claimant also sets forth the evidence that supports his position.

Once a Petition for Review is submitted, a three member panel decides whether to accept it and review the case.  If review is decided upon, the case returns to L&I and the claimant will likely receive some form of benefits.  If the panel rejects a review, then the claim continues in denial.

Further Appeals

If a Petition for Review is denied, then a claimant may still appeal this decision with State Superior Courts, the Washington State Court of Appeals, and even Washington’s Supreme Court.  However, claimants should note that this particular process can prove difficult.  For this reason, an experienced L&I attorney is often recommended for handling a case.

In Fact…

Appealing a workers’ compensation denial, even at the first chance of appeal, can be a grueling and complex process.  The process though is important for an injured worker should rarely be denied benefits following a work related injury.  If your workers’ compensation claim has been denied, don’t wait until it’s too late.  Contact an experienced workers’ compensation attorney to help represent your needs and interests.

The experienced attorneys at Phillips Law Firm have been handling workers’ compensation claims, and appeals wherefrom, for years.  These dedicated attorneys can undoubtedly answer your questions, and if need be, represent you throughout the entire appeals process if your specific claim has been denied.  Simply contact them now and get the justice you deserve.

Real People. Real Justice. (800) 708-6000