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Workers' Comp Appeals Lawyer in Arizona

What Happens If My Claim Is Denied?

What Happens If My Workers’ Comp Claim Was Denied?

If your Arizona workers’ compensation claim has been denied, you will have to appeal the decision in order to receive benefits. Unfortunately, the appeals process can be complex and challenging. Navigating the workers’ comp system on your own is extremely difficult. Having an experienced Arizona workers’ compensation lawyer by your side can help you overcome that burden.

The Arizona workers’ compensation attorneys at Matt Fendon Law Group will fight to seek the benefits you need and deserve. Our lawyers are skilled negotiators. We can help gather the relevant evidence and information you need to reverse that denial.

Call us today to schedule a free initial consultation.

Common Reasons Workers’ Comp Claims Are Denied.

Arizona’s workers’ compensation claims are denied for numerous reasons:

  • Failure to notify the employer in a timely fashion. If you fail to notify your employer of the work injury in a timely fashion, your claim may be denied. Arizona workers are sometimes slow to tell their employer that they were injured – especially if the injury does not significantly affect their ability to work.
  • The condition arose spontaneously, and the cause was unknown. Suppose you injure your back at work, and X-rays indicate that you have scoliosis. If that condition existed prior to the injury, your claim could be denied. A doctor’s exam could provide more information on how your job caused the injury.
  • Injury was from an off-site accident. If you were injured in an off-site accident that was outside the duties of your job or outside of your work hours, your claim would likely be denied. A claim would be denied for an accident that occurred on your work commute. However, if you were hurt in an off-site accident while performing a work-related task, you may be eligible for workers’ compensation benefits. For example, getting injured while traveling to a work meeting or transporting job-related goods might be covered by workers’ compensation.
  • A rule was violated. An employer’s safety rules and regulations are intended to be followed by all employees. Those rules help prevent injuries. However, in some instances a rule may be broken by accident or due to sudden circumstances. A worker’s injury might be covered unless the employer could show the employee intentionally caused the injury or that the employee’s conduct was outside the scope of his or her employment.
  • Workplace misconduct occurred. Arizona is a no-fault state, which means that workers are entitled to compensation even if they were somehow at fault for their injury. However, certain conduct can disqualify workers’ claims. That conduct includes:
    • Engaging in misconduct
    • Engaging in risky activities not related to work duties
    • Intentionally putting themselves in danger
    • Purposefully injuring themselves

How an Arizona Workers’ Comp Appeals Lawyer Can Help

Hiring an experienced Arizona workers’ compensation attorney can help ensure your rights are fully protected. At the Matt Fendon Law Group, we know a claim denial can be stressful for you and your family. We can help you successfully navigate the complicated appeals process. We will fight to get you the compensation you deserve.

Steps in the Workers’ Compensation Appeal Process

  1. Request a hearing. If you are not happy with the outcome of your claim, you have 90 days from the time you receive the denial notice to request a hearing at the Industrial Commission of Arizona (ICA). You must do this in the form of a letter. You or your lawyer must sign your request for a hearing. The ICA will send you a notice with the date for a hearing before an administrative law judge (ALJ).
  2. Participate in a prehearing conference. The ALJ assigned to a workers’ comp appeal may ask the parties to participate in a prehearing conference. This is usually conducted by phone. The prehearing conference gives the judge a chance to discuss the case with the parties.
  3. Participate in the discovery process. Before the hearing, both parties are required to participate in the discovery process. This is the exchange of case-related materials. Discovery allows both sides to request and analyze critical evidence related to the appeal. This also includes the deposition stage where the insurance company’s attorney asks you a series of questions under oath.
  4. The hearing is held. The final hearing is held 90 days after referral to the ALJ in the case. The worker who filed the appeal is typically the first to testify and has the burden of proof. Throughout the hearing, the ALJ may question the participants. A cross-examination may be conducted by the parties’ lawyers. There may be more than one hearing for additional testimony such as medical witnesses. The ALJ renders a decision within 30 to 60 days after the last hearing’s conclusion, typically.
  5. Request to review. If you are not satisfied with the final decision of the ALJ, you may file a request to review within 30 days. The ALJ will re-examine the evidence in the case and issue a decision upon review. The ALJ’s decision will either change or confirm the original decision. If you are still unhappy with the decision, you may file an appeal with the Arizona Court of Appeals within 30 days of the review decision.

How Long Does a Workers’ Comp Appeal Take?

Every workers’ comp case is different. For that reason, it is difficult to say exactly how long your appeal will take. Many cases require more than one hearing. The initial hearing may take only 30 minutes – or it could take several hours. Other hearings are held to take testimony from medical and labor experts. Scheduling these hearings depends on the availability of these experts and may take several months.

The ALJ usually issues a decision within 30-60 days after the final hearing. If you are dissatisfied with the ALJ’s decision, you can take your case to the Court of Appeals, as long as there is a contested legal issue. A ruling from that court could take a year or longer.

Talk to an Arizona Workers’ Comp Appeals Attorney Now

The Arizona workers’ compensation lawyers at Matt Fendon Law Group fight for the legal rights of injured workers. Our skilled and compassionate attorneys are ready to handle all aspects of your workers’ compensation claim. That allows you to focus on your health and recovery. If your claim was denied, we can help you appeal it, and we will fight tirelessly to seek the benefits you deserve.

Call us today to schedule a free and confidential consultation.

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