Any Louisiana workers compensation lawyer knows the feeling of injustice you have when your claim for benefits is denied. You did everything by the book – so why would the insurance company refuse to pay your benefits? Unfortunately, a denied workers comp claim is not the exception, but the norm – especially if you filed it without a lawyer.
However, it is never too late to talk to an attorney and fight for your rights. A denied workers comp claim is not the end of the road. You have the right to appeal it and obtain a positive outcome. Here is an outline of this process.
1. Mediation
Initially, an attorney will try to overturn a denied claim in an amicable manner, through mediation. To this end, they will invite the insurance company to attend a mediation session, coordinated by a third party.
This is not a mandatory step in the appeal process and it does not happen all the time. Usually, insurers are convinced that you will not escalate matters and will refuse to consider mediation.
2. Filing the Appeal
Your attorney will help you fill in Form 1008 (also known as the Disputed Claim for Compensation) and file it with the Louisiana Office of Workers’ Compensation (LWC). The form contains many fields related to:
- Your identification data
- Your employer’s identification data
- When the workplace accident happened
- Details about the accident
- Details of the medical care you received for the injuries you suffered
The form must be filled in completely and with 100% accuracy. Thus, you should let your lawyer assist you with this initial step in the appeal process.
3. Pre-Hearing Proceedings
The pre-hearing proceedings depend on how the workers comp insurance company responds to the appeal. In some cases, they may accept to enter negotiations with your lawyer – this is usually when they know that they have high chances of losing the appeal.
However, in the majority of situations, once you consult with a Louisiana workers comp lawyer and file an appeal, the pre-hearing process includes:
- A preliminary determination if your appeal should proceed, as the insurance company will demand a decision without a formal appeal hearing
- The discovery phase, when both parties will request and exchange information
- The filing of pre-hearing motions and pleadings
When your denied workers comp claim was the result of a simple clerical error corrected during the filing of the appeal, the LWC may rule in your favor before holding any hearing and you will get your benefits.
If no such resolution is reached, the appeal moves to the next phase.
4. The Appeal Hearing
The appeal hearing is very similar to a court hearing. Both your lawyer and the insurer’s legal counsel will present statements outlining their stances in the case. Afterwards, your lawyer will:
- Introduce and question expert witnesses and eyewitnesses
- Present testimony obtained through depositions
- Present evidence related to the accident and its circumstances
- Cross-examine witnesses introduced by the opposing party
- Present documents related to your medical care costs and lost wages
- If necessary, submit a post-hearing memorandum summarizing all of the above
The workers compensation judge will issue their decision within 45 days after the hearing.
Let an Experienced Lawyer Help You Overturn a Denied Workers Comp Claim!
Navigating the appeal process in workers compensation cases is not easy. You have to fill in documents without errors and submit them on specific deadlines. The best decision is to contact a Louisiana workers comp lawyer as soon as possible after your claim was denied.
The lawyer will analyze the evidence you bring and give you a reliable legal opinion on your chances of overturning the denial. If you have a strong case, we will represent you on a contingency fee basis – no fees until we obtain your benefits.
As a new client, you benefit from a free case evaluation, so call us today at 504-420-2755!
