Denied Workers’ Compensation Claims

Boston Workers’ Compensation Attorney

If your workers’ compensation claim has been denied, you need the help of an experienced and aggressive advocate who can fight for your interests. Michael O. Smith is a seasoned Boston workers’ compensation lawyer with over 15 years of experience representing individuals who have been injured or disabled. Mr. Smith fights for clients whose workers’ compensation benefits have been reduced or denied. He has advocated for his clients at hearings before the Massachusetts Department of Industrial Accidents (DIA) and negotiated settlements on their behalf. As a former insurance defense attorney and workers’ compensation claims adjuster, his background is invaluable in countering arguments against your claim for benefits. If your workers’ compensation claim has been denied, call our office today.

Denial of Your Workers’ Compensation Claim

An injured worker has the right to file a workers’ compensation claim to recover medical expenses, lost wages, and other benefits. In many cases, however, an insurer may deny a worker benefits straight away, or may start but subsequently cease paying benefits. In Massachusetts, an insurer may pay an injured worker benefits for up to 180 days after an injury without accepting liability for the injury. This means that the insurer may stop paying benefits at any time during this “pay-without-prejudice” period, so long as they provide the injured worker with seven days’ written notice, a reason for the denial, and their right to appeal. After the pay-without-prejudice period, an insurer may only stop benefits if it has permission from the injured worker or the DIA.

If you apply for workers’ compensation benefits and are subsequently denied, it is important to speak with an attorney right away to ensure that the appropriate forms are filed with the DIA and to secure your right to an appeal.

Appealing a Denial of a Workers’ Compensation Claim

If you receive a notice of denial, you may file an appeal with the DIA. Alternatively, an insurer may ask the DIA to reduce or modify your benefits; either will initiate the dispute process.

Once the paperwork is filed, there are three main stages in the appeals process:

  • Conciliation – The first stage is conciliation, which is a meeting between you, the insurer, and a DIA conciliator. You and the insurer will try to reach an agreement with the help of the conciliator. If an agreement cannot be reached, the next step is a conference before an administrative judge.
  • Conference – At the conference, you and the insurer will each present your case before the judge. You will need to show that you were disabled; that you incurred a work-related injury; and that the medical bills in question are necessary for your treatment. You can present evidence to support your claim, such as medical reports and witness affidavits. The judge will then issue an order on whether or not you are entitled to benefits. The order can be appealed. If either you or the insurer appeals, a hearing will take place.
  • Hearing – While you may not necessarily need an attorney for any part of the dispute process up to this point, the hearing is a legal proceeding. This means that the proceeding will be recorded; that the Massachusetts rules of evidence will apply; and that any testimony will be taken under oath. It is crucial that you present the strongest case and arguments for your claim at a hearing, because once the judge makes his or her decision, it can only be appealed further if the judge made an error in law.

If your claim has been denied, it is important to build a strong case at the outset of the dispute process. An experienced attorney can provide the advocacy and support you need to appeal a denial of your claim.

Determined Workers’ Compensation Advocacy

Michael O. Smith is a Boston workers’ compensation attorney who will fight for your right to workers’ compensation benefits. Mr. Smith represents injured workers whose claims have been denied. He has helped clients navigate the complex and often stressful workers’ compensation dispute process. Mr. Smith can provide you with the guidance you need through each step of the process and advocate for your rights at DIA hearings. We proudly represent clients throughout Boston. Call our office today at 617-263-0060 to arrange an initial consultation at no cost, or contact us online.

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