If your Arizona workers’ compensation claim has been denied, you have a right to an appeal. Given the challenges of navigating the worker’s comp system, it is wise to have an accomplished workers’ compensation claim denial attorney by your side.
Disability Attorneys of Arizona is highly experienced in handling workers’ comp claim denials. Our dedicated workers’ compensation appeals lawyer is a highly respected advocate of injured workers who will fight for the benefits you deserve. Contact our Phoenix office today to schedule a free consultation.
Common Reasons for a Workers’ Compensation Claims Denial in Arizona
Although workers who suffer on-the-job injuries or occupational illnesses are entitled to workers’ compensation benefits, claims are frequently denied for the following reasons:
- Failing to Promptly Notify the Employer About the Injury. One of the most common reasons a claim is denied is that the employee did not promptly notify the employer of the injury, or as soon as reasonably possible. By failing to do so, you may forfeit your right to workers’ compensation benefits. In addition, after receiving your notice, the employer must also report the injury to the Industrial Commission of Arizona (ICA) within 10 days.
- Failing to File a Claim Within the Deadline. You must also file a workers’ compensation claim to the ICA within 1 year of the date of the injury or illness. If your claim is not filed within this time period, or is incomplete, or inaccurate, the claim will be denied.
- The Injury Occurred Outside the Scope of Employment. Your injury must have occurred in the course of performing work-related duties, while on the employer’s premises. If you slip and fall on the sidewalk during a lunch break, for example, you are not eligible for benefits. On the other hand, an injury that occurs while you are running an errand for your employer, such as delivering a package to a client, means that you were on a “special mission” and are therefore entitled to benefits.
- The Employer or Workers Compensation Insurance Carrier disputes the claim. Your employer may dispute that the injury was work-related or the insurance carrier may claim your injury was a pre-existing condition. Therefore, it is crucial to provide evidence, including a statement from the doctor who treated you, that your medical condition is work-related.
Other reasons a workers compensation claim can be denied include:
- Lack of medical evidence to support the claim
- The employee failed to seek appropriate and prompt medical attention
- The employee sought medical care from an unauthorized health care provider
- The injury or illness is not a qualifying medical condition
- A blood test shows drug or alcohol use at the time of the injury
How an Arizona Workers’ Comp Appeals Lawyer Can Help
At Disability Attorneys of Arizona, we know that a claim denial can add to the stress of being injured and unable to work. Our legal team will have you navigate all aspects of the workers’ compensation appeals process, including:
- Request a hearing — You have 90 days from the date you receive the denial notice to request a hearing with the ICA. Your request must be in writing. The ICA will notify you of the date of the hearing, which will be conducted by an Administrative Law Judge (ALJ).
- Prehearing conference — The ALJ assigned to your appeal may require the parties to participate in a prehearing conference (usually by phone) to discuss the case.
- Discovery — Before the hearing, the parties are required to exchange information and material related to the case. The discovery process allows both sides to request and review evidence related to the appeal. Discovery also includes a deposition during which the insurance carrier’s attorney will question you under oath.
- Hearing — A workers’ compensation hearing is held 90 days after referral to the ALJ. You will be asked to testify and must be able to demonstrate that your claim is valid. The ALJ will question all the parties and there may be one or more additional hearings to review the medical evidence.
The ALJ will render a decision within 30 to 60 days after the final hearing. If your appeal is denied, you may file a request to review within 30 days. The ALJ will re-examine the evidence and issue a decision either reversing or confirming the original decision. If your claim is still denied, you have a right to file an appeal with the Arizona Court of Appeals within 30 days of the review decision.
Why Choose Disability Attorneys of Arizona for a Workers’ Compensation Claim Denial
Our firm has a proven history of helping our clients obtain the worker’s compensation benefits they deserve. Whether you are filing an initial claim or need assistance with your appeal, we will guide you through the process and make sure your rights are protected.
Let Disability Attorneys of Arizona handle all the details of your workers’ compensation claim so that you can focus on recovering. Contact our office today to learn how we can help. You will not pay any attorneys’ fees until we obtain benefits for you.