District of Columbia employers have a duty to provide workers’ compensation insurance for their employees, but, unfortunately, claims can be denied, putting injured workers at risk. At the law firm of May Lightfoot, PLLC in Washington, D.C., we help injured workers to appeal insufficient decisions from the Office of Workers’ Compensation. With an in-depth knowledge of the legal protections and benefits workers are entitled to, we aggressively pursue lost wage reimbursement and medical care coverage for our clients in the D.C. area and Maryland. Our lawyers are professional, reliable and focused on your best interest when you suffer an on-the-job injury or illness. Contact us online for a complimentary case evaluation, or call us directly at (202) 919-6463.
How do I appeal a workers’ comp decision in Washington, D.C.?
In Washington, D.C., either an employee or the employer may appeal the original decision of the Office of Workers’ Compensation. You may want to appeal the decision if you were offered fewer benefits than you think you are entitled to, or if your claim was denied outright.
There are several steps to appealing a workers’ compensation decision:
- Informal conference — After your claim is denied, or granted with inadequate benefits, you can request an informal conference with a claims examiner from the Office of Workers’ Compensation. During the conference, the examiner will try to mediate an agreement with your employer’s insurance company and issue a recommendation for terms of compensation within 30 days of the conference.
- Formal hearing — Instead of requesting an informal conference, or after a conference that leads to a poor outcome, you can file an Application for Formal Hearing with the Administrative Hearings Division. If you wish to have a formal hearing, you must inform the OWC in writing within 14 working days, and file for a hearing within 34 working days. At the hearing, which will generally be scheduled for a time within 90 days of your request, an Administrative Law Judge will review the evidence of your case and will ask to hear from you and your employer. Because your employer will likely hire an attorney, it is wise to have an attorney on your side as well. After the hearing, the Administrative Law Judge has 20 days to issue a Compensation Order.
- Compensation Review Board — If you are dissatisfied with the Compensation Order, you have 30 days to request a review from the Compensation Review Board. A panel of judges on this board will review your case and issue a final decision.
- Court of Appeals — If the final decision from the Compensation Review Board is not in your favor, you have 30 days to file an appeal with the D.C. Court of Appeals. In search of a satisfactory benefits decision, an attorney can argue your case in court.
As an alternative to litigation in the Court of Appeals, after the Compensation Review Board issues its final decision, you can submit a request for consideration within 10 days of the decision. The board will then take another look at your case.
Keep in mind that no benefits will be paid out until the appeal process is concluded. This means if you were awarded some benefits but believe you were entitled to more, you won’t receive anything for the time being if you decide to appeal.
Common Reasons Your Claim Might Be Denied
Understanding the common reasons that workers’ compensation claims are denied can help you avoid making the same mistakes. While sometimes a claim denial is unavoidable, often, it’s just about making sure you follow the rules and meet the deadlines. Some of the most common reasons for denied workers’ compensation claims include the following:
- Unexplained or pre-existing injuries
If you had prior injuries that seem to be similar to the ones in your current workers’ compensation claim, or you fail to explain how you were injured, your claim could be denied. Even if your pre-existing injuries have nothing to do with your current claim, some employers attempt to exploit your injuries and use this as an excuse to deny your claim.
- Lack of supporting medical documents
One of the most important aspects of your claim will be the medical records you provide. If you don’t provide the right information or enough information, this can be used as an excuse to deny your claim, even if you should be entitled to compensation.
- Failure to report injuries on time
In order to successfully file a workers’ compensation claim, you must report your injuries within a specified period of time. If you fail to meet the proper deadline, even if you clearly suffered injuries at work and should be entitled to compensation, your claim could be denied and you may receive nothing.
- Employer disputes your injuries
In some cases, your employer may dispute that your injuries actually occurred at work or that the injury was related to your job. It’s also possible for your employer to claim that you were injured as a result of your own carelessness – such as being under the influence at work when you suffered the injury. These are all reasons that an employer can use to deny your claim.
How long does a workers’ comp appeal take?
The length of the appeals process depends on how many steps you need to go through to obtain a resolution. It may take less than a month or several months. While you await a final outcome, you may be prevented from receiving the compensation you need to pay your medical bills and the many other expenses that pile up when you aren’t receiving income.
Advice from an experienced workers’ compensation attorney can be invaluable when you are denied the benefits you need while you’re out of work. Our law firm has helped workers throughout the D.C. area and Maryland to appeal workers’ compensation decisions and is prepared to assist you.
Why It’s So Important to Hire A Lawyer
Workers’ compensation claims and appeals can be very complicated and time-consuming. Claims are often denied for seemingly no reason, and the appeals process can take months at best. When you hire legal representation right off the bat, they can negotiate on your behalf before you get to the point where an appeal is necessary. Litigating a workers’ compensation claim is costly for everyone involved, so if it’s possible to avoid litigation, that’s often the best way to go.
Employers Cannot Retaliate or Discriminate After a Workers’ Comp Claim
Another important point to note is that your employer is not permitted to discriminate or retaliate against you for filing a workers’ compensation claim. This means there can’t be any adverse employment actions taken against you as a result of the claim. If your employer violates this law, they can be fined up to $1,000, and you would be entitled to back pay and restoration of your previous employment position if the adverse action altered it in any way.
Contact a respected Washington, D.C. workers’ compensation appeals law firm today
Located in the District of Columbia, May Lightfoot, PLLC fights workers’ compensation claims denials in Maryland and the Washington, D.C. area. To schedule a free initial consultation with one of our experienced attorneys, call (202) 919-6463 or contact us online.