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What to do if your workers’ comp claim was rejected?


As If Getting Injured Wasn’t Bad Enough

Suffer a workplace injury — seeing the doctor, possibly going to the ER, trying to recover, and keeping your lights on? Bad. Doing all that to find out your claim has been rejected? Worse. If you find yourself spiraling down the hole of worry and confusion, read on. We’ve broken down the process on how to appeal a workers’ comp claim, or at least give you a starting point to hopefully help carry the burden.

Submitting L&I (Workers’ Compensation) Claims

The first steps for filing claims for an industrial injury or occupational disease typically begin at your doctor’s office or the emergency room. If the doctor deems that your injury or condition is related to your work, they will fill out and submit a claim to the Department of Labor and Industries on your behalf. Like some legal matters, it’s worth noting that L&I claims can be complex. (It’s okay. That’s why we’re here.)

Once L&I receives your claim, they will notify your employer and start the process of determining if you are eligible for treatment and benefits.

If all goes smoothly, L&I will find that your injury or condition is related to your employment, and you can get started on the path toward getting treatment and getting better. However, life doesn’t always go so smoothly. So, we’re here to walk you through some of the reasons your claim got rejected and how to protest or appeal a workers’ compensation claim.

Reasons Your Claim Was Rejected

Rejection hurts. We get it. But this isn’t the end of the road for you. There are several reasons claims get rejected. Often the question revolves around whether you have a doctor stating that you have a treatable condition that was related to either a specific incident at work or occurred from repeated exposure or work activity. For example, if you fall off a ladder versus years of carrying bundles of shingles up and down that ladder, causing your back or joints to degenerate.

Another issue can be that you may have a pre-existing condition that was “lit-up” or made worse by an on-the-job accident or exposure, which (provided you have a doctor stating so) can be eligible for treatment and benefits under your claim. Still, it can muddy the waters a bit.

What happens when your claim gets rejected?

The 60-Day Window

Once you receive word that your claim got rejected, you have 60 days before the decision becomes final. This time period is crucial and must be watched carefully. If you miss this deadline, you lose your right to stand up and say, “THIS IS WRONG!” Or at least have anyone at the Department or Board of Appeals listen.

What to Do After Your Claim Gets Rejected

Consulting a Lawyer

If you’re not already working with one, you’ll want to act fast and consult with a lawyer to discuss the next steps if your claim gets rejected. A legal professional understands the missing pieces in your claim and how to approach each unique situation. There is rather specific language pulled from statutes, significant Board of Industrial Insurance Appeals decisions, and case law that may need to be used to demonstrate the legitimacy of your claim, as well as the availability of curative treatment for which your doctor is likely already advocating.

Speaking the “Magic Language”

Sometimes what seems obvious isn’t quite enough — for example, the difference between possibly and probably. It seems like a subtle difference but it could mean success or failure in your claim. Your doctor may have been too indirect in their statement regarding your injury. If anything is vague or open to interpretation, your employer or the Department of L&I will usually fight back.

How to Appeal a Workers’ Comp Claim

As workers’ compensation attorneys serving both the Central & Eastern Washington area, we want to move the legal process along in a time-efficient manner while keeping it as stress-free as possible, so you can get the treatment and benefits you need to recover. If you need help protesting or appealing your claim from a workplace injury or occupational disease, we are here to help get you the compensation and care you deserve.

What’s next? The experienced attorneys at Carlisle + Byers can point you in the right direction. Complete our simple form to schedule a free consultation today.

Photo by Maria Ionova from Unsplash