Michigan workers’ comp lawyer explains the appeals process when the employer or insurance company makes the decision to deny your claim.
Workers’ comp benefits are disputed for a variety of reasons. It can be based upon late notice, failure to make a timely claim, preexisting medical conditions, or misconduct. Some disabled employees have their workers’ comp benefits disputed based upon the independent medical examination (IME). It does not matter why the insurance company disputes workers’ comp benefits. The result is no lost wages or medical care will be paid. Unfair decisions should be challenged with a hearing. Unfortunately, it can take 12 months or longer for a case to run its course. Here is what injured workers need to know about their workers’ comp appeal rights when the insurance company or employers makes the decision to deny your claim.
What is a workers’ comp dispute letter?
In Michigan, insurance companies are required to file a Notice of Dispute (Form WC-107) if workers’ comp benefits are not going to be paid. This form indicates to the State of Michigan that a dispute exists regarding a claim.
It lists six broad categories that can be selected as the reason for a dispute. Watch out for generic excuses like “pending investigation” or “medical records under review.” Biased medical opinions from IME doctors should always be challenged.
How do I start an appeal?
Injured workers who wish to file a appeal can fill out the Application for Mediation or Hearing (Form WC-104A). This workers’ comp form is used by the injured worker to start a case. Depending upon the circumstances, the case will be set for either telephone mediation or pre-trial. Details about the work injury and other personal information will be required.
Do not start a workers’ comp case without consulting an experienced lawyer. Do not expect a magistrate to award benefits using common sense. Rules of evidence and specific procedures must be followed. Medical, vocational, and witness testimony will be needed.
How long do workers’ comp appeals take?
It can take months or years to resolve a workers’ comp appeal. A magistrate might issue an award but that does not mean litigation will end. Insurance companies can file additional appeals all the way to the Michigan Supreme Court. An experienced attorney can help speed up the process and obtain a settlement.
What are the chances of winning a workers’ comp appeal?
The chances of winning an appeal are far greater with an experienced workers’ comp lawyer on your side. With an appeal, the magistrate decides the facts and law of each disputed case. Either side can win or lose at trial. This is a powerful incentive for both parties to negotiate a settlement.
The burden of proof is always on the injured worker, and it can be difficult to establish medical causation and disability under the rules. This is especially true for individuals with preexisting conditions. Medical evidence showing a change of pathology will be required. Insurance companies can also use “phantom wages” to reduce the weekly benefit amount. It is not enough to show inability to work at your job.
Need help? Contact our Michigan work injury attorneys now for a free consultation!
If your looking to appeal the decision of your workers’ comp claim denial, call us now, or fill out our contact form for a free consultation. There is absolutely no cost or obligation. We’re here for you.
Our attorneys have been exclusively helping injured workers in Michigan for more than 40 years. Our attorneys can help you better understand workers’ comp laws and what happens after someone has been hurt on the job. To see what our own clients have to say about the caring, compassion, and communication they received from us, you can read in their own words about their experience here on our testimonials page from clients we have helped.
Michigan Workers’ Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 40 years. Call (844) 316-8033 for a free consultation today.
Related information:
