In most cases, injuries on the job are usually covered under an employer’s workers’ compensation insurance, Utah requires that employers be covered according to their average level of risk for a given industry. However, if your workers’ comp claim is denied, there are still options. You may be able to file an appeal of the denial through the Utah Labor Commission. There are some prevalent reasons that a claim could be denied.
Why Are Workers’ Comp Claims Denied?
If your workers’ compensation claim has been denied, you first should try to determine the cause. This will probably be explained in the official denial letter. It is possible that you were denied just because you did not meet eligibility requirements, like being injured while engaging in “horseplay” or while not on the job. However, if you think that the denial is an error, you are able to appeal the decision.
Common causes for workers’ comp benefits denials include — but are not limited to — the following factors:
- Injury was not reported in time. Utah has established regulations that mandate when you must inform your supervisor of any injuries sustained on the job. In Utah, you are required to inform your supervisor within 180 days.
- Claim was not filed in time. State law in Utah has a set deadline for filing an initial workers comp claim. In Utah, you must file your claim within one year following the accident.
- Employer dispute. Your employer could dispute your claim by arguing that it took place off the job, was due to horseplay on part of the injured party, or another disqualifying reason.
- Injury is not compensable. Claims involving stress-related injuries, for instance, can be hard to prove in certain cases.
- Lack of medical treatment. In a majority of cases, you are required to obtain medical treatment to be able to receive workers’ comp benefits.
- Inadequate evidence that injury is work-related. It may not always be certain if the injury took place on the job, but another medical appointment or some other evidence may strengthen your claim.
What if My Claim Is Denied?
If your claim for workers’ comp benefits has been denied, or the insurance provider is disputing a part of your claim, you have the legal right to appeal this decision with the Utah Labor Commission. To appeal a denial of your claim, you are required to complete a form referred to as an “Application for Hearing-Industrial Accident Claim.” After the Commission receives the appeal, your employer or their insurance provider will be asked to file a response known as an “Answer” within 30 days. After the Answer is filed, the Commission will then schedule an in-person hearing in front of a workers’ comp judge. Hearings are usually scheduled at a minimum of four months out, but could possibly be many months away. Both involved parties usually gather evidence and prepare their arguments prior to the hearing during this time.
Will I Be Able to Settle My Case?
The Commission has a mediation program deemed the Claims Resolution Conference program which is completely voluntary. If both sides agree to take part, the Commission will schedule an informal settlement conference. If you think you may be interested in the program, you are able to apply for a settlement conference on the first page of your Application for Hearing. A neutral third party will collaborate with you and the insurance provider in order to reach a voluntary settlement.
In the state of Utah, there are two kinds of workers’ comp settlements: compromise agreements and commutation agreements. Regarding a compromise agreement, there is usually some dispute over your sustained injuries and you agree to accept a portion of eligible benefits in order to avoid going to a hearing. You are already receiving weekly benefits in a commutation agreement. However, you are requesting they be paid in a lump sum. All settlements are required to be approved first by the Utah Labor Commission.
If you and the insurance provider are unable to reach an agreement, your case will proceed on to the hearing stage.
What Happens at a Workers’ Comp Hearing?
The appeal hearing will usually happen face-to-face at the Salt Lake City or St. George locations of the Utah Labor Commission. Hearings are scheduled to be at least two hours, but can sometimes take many more depending on the circumstances of the case. Each involved party will have a chance to present witnesses, submit documents, and make legal arguments at the hearing. Your hearing will be provided over by an administrative law judge who will mail a written decision to both sides.
Can I Appeal the Judge’s Decision?
You are able to file a Motion for Review within 30 days if you disagree with the judge’s final decision. Your appeal will then be heard by the Labor Commissioner or the Commission Appeals Board. If this does not satisfy you with the decision of the Commission, you are again able to appeal through the state court system through filing a Notice to Appeal with the Utah Court of Appeals.
Should I Hire a Workers’ Comp Lawyer?
The hearings involving workers’ compensation claims are much like court procedures and will likely follow complex procedural regulations. In many cases, an injured worker will need the help of a qualified Salt Lake City workers’ comp attorney in order to ensure a successful case.
Workplace Injuries in Salt Lake City
On the job, accidents happen all the time, but they are more prevalent in certain industries.
In fact, the construction field accounts for a majority of accidents, with 20.7 percent of all fatal injuries happening on a construction site. These injuries are due to a host of reasons and could be the fault of an employer, a third-party contractor, or even another employee. Whatever the case, injured workers should protect their legal rights by contacting a Utah workers’ compensation attorney.
Siegfried & Jensen has decades of experience helping injured workers successfully file workers’ compensation claim. We will work diligently to get you and your family the compensation you deserve. Please, if you have been injured on the job, call us today at 801-845-9000.