Springfield Workers’ Compensation Denial Lawyer

If your workers’ compensation claim is denied, the next step is often an appeal. A Springfield workers’ compensation denial lawyer from our firm could help you through this process by reviewing your claim, explaining your options, identifying the basis for an appeal, and seeking the benefits you are entitled to receive.

At Pellegrini, Seeley, Ryan & Blakesley, P.C., we handle more workers’ compensation cases than any other law firm in Worcester and Western Massachusetts. Our workers’ compensation attorneys represent injured workers with a practical approach and a strong focus on protecting their rights.

What Can You Do if Insurance Denies Your Workers’ Compensation Claim?

Almost every employee has workers’ compensation coverage through their employer. Workers’ compensation is no-fault, which means you do not have to prove that someone else caused your injury or illness to receive benefits.

However, you still need to prove that your injury is severe enough to warrant medical treatment and time away from work. If the insurance company disputes the seriousness of your condition or identifies another issue with your claim, it may deny benefits.

If that happens, you can appeal, and an attorney who handles workers’ compensation denials in Springfield could help you navigate the process.

Common Reasons for Workers’ Compensation Claim Denials

There are many reasons an insurance company may deny your claim. Some are simple and straightforward, while others are more complex. Sometimes, insurance companies deny claims to test their validity or avoid paying benefits.

Common reasons for workers’ compensation denials include:

• Failure to promptly notify your employer about your injury or illness
• Failure to provide sufficient medical evidence
• Failure to provide evidence that your condition is work-related
• The insurance company attributes your injury or illness to a pre-existing condition
• The insurance company believes you caused your injury through misconduct, such as being intoxicated while working

Our lawyers in Springfield could review your workers’ compensation claim and help you understand why the insurance company denied it. We could gather evidence to support your case on appeal, such as medical records, witness statements, and workplace accident reports.

If you contact us as soon as you are injured or diagnosed with a work-related condition, we could help you prepare your initial claim and avoid mistakes that could result in a denial.

What Happens During a Workers’ Compensation Denial Appeal?

There is an appeals process if the insurance company denies your claim or if your employer refuses to file a claim within 30 days of your injury or illness.

To challenge a denial, you must begin by filing an Employee Claim (Form 110) with the Massachusetts Department of Industrial Accidents (DIA). Before you do so, the DIA’s Injured Workers Guide to Workers’ Compensation recommends that you consult an attorney.

Depending on whether the claim resolves at an earlier point, your appeal may progress through several stages. These stages include:

• Conciliation: This is an informal meeting between you and the insurance company to determine whether you can resolve your claim voluntarily
• Conference: During this informal proceeding, you and the insurance company present evidence before an Administrative Law Judge (ALJ), who then issues a conference order approving or denying your claim
• Mediation: If either party disputes the conference order, both sides may attempt to resolve the matter through mediation
• Hearing: If mediation does not resolve the claim, you and the insurance company will have a formal hearing before the ALJ who presided over your conference
• Review Board: You or the insurance company may appeal the ALJ’s hearing ruling, but you must show that the judge made an error of law to overturn their decision
• Court of Appeals: You or the insurance company may appeal the Review Board’s decision to the Massachusetts Court of Appeals

A Springfield attorney from our firm could help you build your workers’ compensation appeal after a denial and represent you at every stage of the process. We have nearly 70 years of legal experience, and we could use that knowledge to help you pursue the benefits available in your case.

Contact a Springfield Attorney for Help After a Workers’ Compensation Claim Denial

If your insurance company denies your claim, a Springfield workers’ compensation denial lawyer from our firm could help you pursue benefits through an appeal. We are committed to helping you secure the compensation you deserve. Contact us today for a free consultation.