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Appealing a Denied Claim

The Commonwealth of Massachusetts has a system in place to help workers who get hurt on the job. It’s called workers’ compensation and it provides income and medical benefits to those who sustain work-related injuries. However, many times these claims will be denied or disputed by the workers’ comp insurance company that your employer carries. If you are appealing a denied claim, you will need the legal guidance of an experienced Lowell workers’ compensation attorney.

Appealing a Denied Claim | Conciliation

If a worker and workers’ compensation insurer disagree about a claim, the Massachusetts Department of Industrial Accidents (DIA) has four steps available to try and reach an agreement among the parties: conciliation, conference, hearing, and Reviewing Board.

Conciliation consists of an informal meeting between the worker, the worker’s attorney (if he or she has one), an attorney for the workers’ compensation insurance company and the DIA conciliator. The conciliator serves as a neutral third party to try and help negotiate a settlement.

Appealing a Denied Claim | Conference

The second step is the conference (sometimes referred to as a proceeding). And while the worker still isn’t required to have an attorney, it’s strongly recommended they have an experienced workers’ compensation hearings and appeals attorney with them for this process. This is because even though a conference is an informal meeting between the workers’ compensation insurance company and the worker, instead of being before a conciliator, it’s in front of an Administrative Judge.

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Appealing a Denied Claim | Hearing

At the hearing, both sides present evidence in support of their position and may call witnesses to testify. In certain situations, either side may be required to submit new evidence before the Administrative Judge issues a decision. If either side is unhappy with the Administrative Judge’s decision, they can appeal it to the Reviewing Board.

Appealing a Denied Claim | Reviewing Board

At this level of the workers’ compensation settlement process, the parties may only present legal arguments in support of their position. Generally speaking, no new evidence may be presented to the Reviewing Board. If the Reviewing Board feels additional evidence is necessary, they will usually remand the case back to the Administrative Judge for further consideration of additional evidence.

No matter what, the parties must present legal briefs to the Reviewing Board. These legal briefs will explain the basis for their legal position. The Reviewing Board will sometimes ask for more from the parties, such as coming before the Reviewing Board to present their legal arguments in person.

If either side is still unhappy with the Reviewing Board’s decision, they may file another appeal with the Massachusetts Court of Appeals. A workers’ compensation appeal to the Massachusetts Court of Appeals is a fairly rare occurrence.

To learn more about the workers’ compensation dispute resolution and appeals process, please contact our office for a consultation with a dedicated Massachusetts workers’ compensation hearings and appeals attorney. Let our experience work for you.

Don’t Wait. Insurers only have 14 days to pay or deny your claim. Learn how to improve your chances of having your claim approved.