What To Do If Your Workers’ Comp Claim Gets Denied?

A denied claim does not necessarily mean you’re ineligible for workers’ compensation. In fact, many initially denied claims are later approved through the appeals process.

Our experienced workers’ compensation lawyers understand the frustration and uncertainty that comes with a claim denial, and we’re here to guide you through each step of the appeals process.

Why Was Your Colorado Workers’ Comp Claim Denied?

Workers’ compensation claims can be denied for various reasons, many of which can be challenged with the right evidence and approach. By identifying the cause of your denial with the help of a workers’ compensation lawyer, you can better prepare the necessary documentation and take the appropriate steps to strengthen your case.

1. Missed Reporting Deadlines

Under C.R.S. § 8-43-102, Colorado workers must report workplace injuries to their employer within ten days of the accident. Missing this deadline could result in an automatic denial of your claim.

If you’ve missed the reporting deadline, exceptions may apply depending on your circumstances, such as cases involving delayed symptoms or lack of awareness about the injury’s severity. It’s essential to document the reasons for the delay and gather supporting evidence that could justify late reporting.

2. Employer or Insurer Disputes Your Claim

Employers or insurance companies may dispute a claim by arguing that the injury did not occur at work or during work-related duties. Common disputes include:

• Whether the injury occurred on the job
• If the employee was engaged in work-related tasks
• Lack of witnesses to the accident

When facing a dispute, providing consistent details about how the injury happened, along with workplace incident reports and witness testimonies, can help counter the insurer’s arguments. Medical records and expert opinions may also strengthen your case by establishing a clear connection between the injury and your job duties.

3. Insufficient Medical Evidence

If medical records don’t explicitly link the injury to your job, the insurer may deny the claim. It is also necessary to understand what types of workers’ compensation benefits may apply to your case, such as temporary disability, permanent disability, or medical treatment coverage.

If your initial medical report lacks sufficient detail, consider requesting a more thorough evaluation or consulting a specialist. Keeping detailed records of all medical visits, treatments, and prescriptions can also serve as valuable evidence during the appeals process.

4. The Injury Is Not Considered “Compensable” Under Colorado Law

Colorado workers’ compensation laws cover injuries that occur within the scope of employment (C.R.S. § 8-41-301). However, certain exclusions apply, such as injuries that occur during breaks, off-duty hours, or due to intoxication.

Injuries sustained during work-related travel, offsite assignments, or company-sponsored events may still be eligible for benefits, even if they occurred outside the primary workplace.

If your workers’ comp claim was denied, it’s important to remain proactive and informed. Whether the denial is due to missed deadlines, disputes from your employer, or lack of medical evidence, gathering the right information and following proper procedures can significantly improve your chances of overturning the decision.

Steps to Take After a Workers’ Comp Denial in Colorado

Receiving a workers’ compensation denial can be frustrating, but it doesn’t automatically mean your claim is over. Colorado’s workers’ compensation system allows injured workers to challenge denied claims through a structured appeals process. At Boesen Law, we have extensive experience helping injured workers in Colorado recover rightful compensation.

Below are the essential steps to take if your workers’ comp claim has been denied:

1. Review Your Denial Letter Carefully

The denial letter from the insurance company will outline the specific reasons your claim was rejected. This letter is a critical document because it highlights the insurer’s justification for the denial. Carefully review the letter for details such as:

• Missing paperwork or documentation
• Disputes over whether the injury was work-related
• Allegations that deadlines were missed
• Lack of sufficient medical evidence

If any of the reasons appear to be based on incorrect information, addressing these discrepancies should be a top priority.

2. Request a Hearing with the Colorado Division of Workers’ Compensation (DOWC)

If you’re unable to resolve the denial directly with the insurance company, the next step is to request a hearing with the Colorado Division of Workers’ Compensation. This hearing is held before an Administrative Law Judge (ALJ) who will review your case and issue a decision.

To initiate this process, you must file a Request for Hearing. During the hearing, you will have the opportunity to present evidence, call witnesses, and explain why your claim should be approved.

3. Gather Additional Medical Evidence

One of the most common reasons for a workers’ compensation denial is insufficient medical evidence. Insurance companies often argue that medical records do not adequately link the injury to the workplace accident. To address this, consider obtaining additional medical documentation such as:

• A detailed report from your treating physician explicitly connecting your injury to your job duties
• A second opinion from another healthcare provider
• An Independent Medical Examination (IME) conducted by a neutral third-party doctor

Obtaining comprehensive medical documentation can significantly bolster your claim and demonstrate the severity and work-related nature of your injury.

When to Consider Legal Assistance in Colorado

The workers’ compensation appeal process in Colorado is filled with complex legal nuances and strict filing deadlines that can be overwhelming when you’re already dealing with an injury. Without proper legal guidance, crucial evidence might be overlooked or deadlines missed, potentially costing you the benefits you deserve.

At Boesen Law, our specialized workers’ compensation attorneys bring years of experience fighting denied claims. We know exactly how insurance companies operate and the tactics they use to minimize payouts. Contact us today for a free, no-obligation consultation to discuss how we can help with your specific case.