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What Are the Chances of Winning a Workers’ Comp Appeal?

Published February 14, 2024 by Matt Fendon Law Group | Workers' Compensation

Most workers’ compensation claims in Arizona are approved upon their submittal. But what happens if your workers’ compensation benefits claim is among the minority of applications that the Industrial Commission of Arizona (the ICA) denies? Fortunately, you have the right to legal representation in a claim denial appeal. 

At the Matt Fendon Law Group, our workers’ compensation attorneys handle ICA denials of initial workers’ compensation claims. Many workers’ compensation denial appeals are successful, especially if you have the help of an experienced workers’ comp lawyer. Call us at (800) 229-3880 to speak with an experienced workers’ comp attorney about your claim denial.

What Are the Chances of Winning a Workers’ Comp Appeal?

According to one national study, nearly 7% of workers’ compensation claims were denied through 2013-2017.

Of those denied claims, about two-thirds were paid within a year.

While research is insightful, every case is different, and it’s not possible to answer what chance a certain workers’ compensation claim has for a successful appeal.

However, hiring a competent and experienced workers’ compensation appeal lawyer, like the ones here at Matt Fendon Law Group, can increase the likelihood of winning your appeal significantly.

How to Improve Your Chances of Winning a Denied Workers’ Comp Appeal

To employers and workers’ compensation insurers, key considerations in deciding whether to contest an appeal of a denied workers’ compensation claim are the cost of defending the appeal and the prospect of a court reversing the denial. The money supposedly saved by at first refusing to pay out a claim can be more than offset by the legal costs if the claimant successfully appeals, which happens most of the time. 

In the same study referenced above, the average cost of an initially approved workers’ comp claim was a little more than $10,000, but the average cost of the two-thirds of initially denied claims that were later paid was more than $15,000—a cost increase to the insurer of 50 percent.

It follows, then, that your odds of winning your appeal of a workers’ compensation claim denial increase when you are well prepared to challenge a denial. 

Having effective legal representation during the appeal process increases the chance that the insurance company will reconsider its claim denial before it is ordered to do so by a court. This is where working with a Matt Fendon Law Group attorney can be valuable to you.

An experienced workers’ comp lawyer can help you gather all the available evidence you need to support your side of the story, help you assess the true value of your claim, and deal with the insurance company and its attorneys on your behalf.

The Arizona workers’ comp appeals process can be difficult to navigate on your own, especially when it comes to gathering sufficient proof to establish a work connection to your injury, illness, or medical condition.

Having a reputable law firm and an experienced workers’ compensation attorney by your side in an appeal improves your chances of receiving fair compensation in two ways. 

First, a workers’ comp lawyer can make sure that your appeal documentation is complete and that it gets filed on time. You will not lose because of a technicality.

Second, having a law firm to represent you throughout the appeal takes much of the stress off of your mind. We deal with your employer, the insurer, and the Administrative Law Judge (ALJ). We make sure you don’t miss a deadline. Additionally, one of our quality Phoenix workers’ compensation attorneys will present your workers’ comp case before the ALJ.

Common reasons for denied workers' comp claims in Arizona

How the Workers’ Compensation Appeal Process Works in Arizona

A denial of your initial claim can be frustrating and disheartening at first, but you should know that it is not the final word in the workers’ compensation appeals process. Arizona workers’ compensation laws include a procedure for you to appeal your claim denial.

How the workers' compensation appeal process works in Arizona

Requesting a Hearing

Ordinarily, your appeal will take the form of requesting a hearing with the Claims Division of the ICA. You must do this within 90 days of the date of the denial letter you receive.

In some cases, the ALJ will have you and your employer’s insurer participate in a pre-hearing conference and can direct both sides to engage in an information-sharing process known as “discovery.” The purpose of discovery is to make sure that both sides have access to all the relevant information that the other has about the claim and its denial. In some cases, you might be required to give a deposition as part of the discovery process.

The hearing itself will take place before an Administrative Law Judge (ALJ). This part of your workers’ compensation case has some similarities to a trial, including the ability of both sides to present evidence to the judge and to cross-examine each other.

When the hearing is complete, the ALJ will usually decide the matter within 60 days and notify you and your employer of the decision by mail.

Appeals to the Arizona Court of Appeals

If, on the other hand, the Administrative Law Judge upholds the initial claim denial, you still have another appeal option. This one is to the Arizona Court of Appeals. You have 30 days after the ALJ upholds the claim denial to request this final appeal.

However, because every case is different, not all cases will be eligible for the Court of Appeals.

Reopening a Closed Workers’ Compensation Claim

In some situations, you can receive workers’ compensation benefits but learn later that they are not enough to compensate you as much as needed. Arizona workers’ compensation includes a procedure for you to request a reopening of your claim to address this concern. 

There is no Arizona statute of limitations or other time limit after which you can no longer request a claim reopening.

You are eligible to reopen your claim if you can prove that you have a new, additional, or previously undiscovered condition since your claim was closed.

The process to reopen a closed workers’ compensation claim begins when you make a petition to reopen with the insurance carrier. This petition needs to include supporting evidence, such as a new medical examination and treatment records. Once you do this, the insurer will have 21 days to respond by either reopening the claim or denying the petition. 

If the workers’ compensation insurance company denies your workers’ comp claim reopening petition, then we recommend contacting an experienced Arizona workers’ compensation attorney to learn what your next options are.

The Bottom Line

The Arizona workers’ compensation attorneys at Matt Fendon Law Group will fight to seek the benefits you deserve. Our lawyers are knowledgeable and skilled negotiators who will collect the evidence and information needed to reverse the denial.

If you have received a denied claim letter for your Arizona workers’ comp benefit claim, remember that you only have a limited time to file an appeal. Don’t wait. Call the Matt Fendon Law Group at (800) 229-3880 to set up a free initial consultation with an experienced workers’ compensation lawyer today.

We have offices in Phoenix, Prescott, Flagstaff, Scottsdale, and Tucson. If you prefer to contact us online, you can ask a question or schedule a free consultation here.

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