If you suffer an injury at work and make a workers’ compensation claim, you may get a denial from the insurer. It may prevent you from getting benefits owed to you.
Mass.gov explains that once you receive a denial for your workers’ compensation claim, you can begin the process of filing an appeal to get a review of your claim.
How to appeal
You can appeal a denial by mail or in person. You will do so by contacting the Department of Industrial Accidents. The appeal will include your employer’s insurance company, but the DIA will handle the review and provide a final judgment in the case. The rulings of the DIA are binding so the insurance company must comply. Having the DIA make the decisions helps to keep the impartial nature of the appeals process.
To appeal, you need to gather documentation about your injury and your workers’ compensation claim. You will need medical documentation that explains your injury and treatment. You also need to provide details about when the injury happened and how much work you have missed as a result. Your paperwork must also include information about the benefits you wish to receive and name the insurance company that denied your claim.
You will complete a Form 110 – Employee Claim and then send this form and your documentation to the DIA. You will send a copy also to the insurance company.
The DIA will then send you a notice that will either reject your appeal due to missing information or set up a conciliation with you and the insurer.