At the Law Office of James M. Hoffmann, we have helped injured workers in Missouri recover their rightful benefits. Schedule an appointment today.
Receiving a workers’ compensation denial can be frustrating and overwhelming, especially when dealing with medical bills and lost wages. However, a denial does not mean the end of your case. In Missouri, you can appeal the decision and fight for the benefits you deserve.
Call (314) 361-4300 today for a FREE consultation, or visit hoffmannworkcomp.com to learn more about your rights and options.
Common Reasons Workers’ Comp Claims Get Denied in Missouri
Before filing an appeal, it’s essential to understand why your claim was denied. Common reasons include:
- Missed Deadlines: Failing to report the injury within 30 days or file a timely claim.
- Employer Disputes: The employer claims the injury was not work-related.
- Insufficient Medical Evidence: Lack of medical records linking the injury to your job.
- Pre-Existing Conditions: The insurance company claims your injury is due to a prior condition.
- Substance Use: A positive drug or alcohol test after the accident.
(Missouri Division of Workers’ Compensation – Workers’ Compensation Rights)
Step 1: Request a Written Reason for Denial
The first step after receiving a denial is to request a written explanation from the insurance company. Under Missouri law, you must know the specific reasons for the refusal.
- Why It’s Important: Understanding the exact reason for the denial helps you gather the appropriate evidence for your appeal.
- Request this explanation in writing and keep a copy for your records.
Step 2: Gather Evidence to Support Your Appeal
Once you understand why your claim was denied, gather evidence to address those reasons. This may include:
- Medical Records: Obtain detailed medical reports from your treating physician linking your injury to your job.
- Witness Statements: Collect statements from coworkers who saw the accident.
- Accident Reports: Ensure that your injury was documented adequately with your employer.
- Second Medical Opinion: If the insurance company’s doctor minimized your injury, seek an independent medical examination (IME).
Step 3: File a Formal Claim with the Missouri Division of Workers’ Compensation
If the insurance company denies your claim, you can file a formal appeal with the Missouri Division of Workers’ Compensation (DWC). This is known as filing a Claim for Compensation (Form WC-21). (Missouri Division of Workers’ Compensation – Filing a Claim)
How to File: Complete Form WC-21 and submit it to the DWC office.
Deadline: You must file the claim within two years from the date of injury or the last payment of benefits.
Step 4: Participate in Mediation or a Pre-Hearing Conference
After you file your claim, the DWC may schedule a mediation or pre-hearing conference to resolve the dispute without a formal trial.
- Mediation: A voluntary process where both parties try to reach an agreement with the help of a neutral mediator.
- Pre-Hearing Conference: A meeting before a judge to discuss the issues and possibly settle the case.
Step 5: Attend a Hearing Before an Administrative Law Judge (ALJ)
If mediation fails, your case will be formally heard before an Administrative Law Judge (ALJ). This is similar to a trial but less formal.
- What Happens at the Hearing:
- Both sides present evidence and call witnesses.
- Medical experts may testify regarding your injury and treatment.
- The judge listens to both sides and reviews all submitted evidence.
- The Judge’s Decision: The ALJ will issue a written decision either approving or denying your claim.
What If You Disagree with the Judge’s Decision?
1. File an Appeal with the Missouri Labor and Industrial Relations Commission (LIRC)
If the ALJ denies your claim, you can appeal the decision to the Missouri Labor and Industrial Relations Commission (LIRC).
- Deadline: You must file the appeal within 20 days of the ALJ’s decision.
- The LIRC Review: The commission reviews the ALJ’s decision and may affirm, reverse, or modify it.
2. Appeal to the Missouri Court of Appeals
If you disagree with the LIRC’s ruling, you can appeal to the Missouri Court of Appeals. This is a higher level of review that focuses on whether the law was applied correctly.
How Long Does a Workers’ Comp Appeal Take in Missouri?
- Mediation: A few weeks to a few months.
- Hearing before ALJ: 6 months to over a year.
- Appeals with LIRC: Several months to a year.
- Missouri Court of Appeals: 1 to 2 years.
The process can be lengthy, but an experienced workers’ comp attorney can help expedite your case and fight for your rights.
Frequently Asked Questions About Workers’ Comp Appeals in Missouri
Can I work while appealing a denied workers’ comp claim?
Yes, but you should consult with your attorney to ensure it won’t negatively impact your case.
Can I get benefits during the appeal process?
Typically, you will not receive benefits during the appeal unless a settlement is reached or the judge rules in your favor.
Is there a time limit for filing a workers’ comp appeal in Missouri?
Yes, you must file your claim within two years of the injury date or the last payment of benefits.
Fight for the Benefits You Deserve
A denied workers’ comp claim can be discouraging, but with persistence and the right legal support, you can successfully appeal and secure the compensation you deserve. Knowing your rights and following the proper steps is crucial to protecting your case.
At the Law Office of James M. Hoffmann, we have helped injured workers in Missouri recover their rightful benefits for over 30 years, even after initial claim denials. Our team is ready to guide you through every step of the appeals process and fight aggressively on your behalf.