How to Appeal a Denied Workers’ Compensation Claim In Missouri

Being injured while on the job is more than just painful, it’s also frightening when it impacts your ability to work and provide for yourself and your family. Fortunately, workers’ compensation insurance is a reliable cushion to fall back on while you recover. Missouri law requires all employers with five or more workers to carry this insurance. But what happens when the cushion you counted on is pulled out from under you because workers’ compensation denies your claim?

If workers’ compensation insurance denies a valid claim, you don’t have to accept the initial denial. Fortunately, the appeal process gives injured employees a second chance at recovering the compensation and medical care they need to regain their physical health before returning to the workplace.

Common Reasons for Missouri Workers’ Compensation Claim Denials

Workers’ compensation policies are made available to employers through private insurance companies with profits as their motive. Workers’ compensation sometimes denies claims due to procedural problems. The most commonly cited reasons for Missouri workers’ compensation claim denials include the following:

• The injured employee didn’t submit a written notification of the injury to their employer within 30 days of the injury date
• The injury victim waited too long to seek medical care
• The employee used a medical provider that wasn’t on their employer’s approved provider list
• The injury victim didn’t follow their doctor’s orders
• The employer offered a light-duty position after approval by the injury victim’s doctor and they refused the position
• The claim was filed after the two-year statute of limitations passed or two years from the date of the last medical payment toward the injury

Workers’ compensation requires stringent adherence to their regulations and filing dates for approval. Hiring a workers’ compensation attorney for your initial claim helps to avoid denials; however, denial doesn’t have to be the end. One study found that workers’ compensation approves nearly 70% of claims after an appeal. For example, many claims receive denials due to an employee’s failure to provide written notice to their employer despite their verbal notice, but under Missouri RSMo § 287.110.2, the law states the following:

“If Employee can show that Employer had actual notice of the injury, even if the notice was not provided by Employee, the written notice defense may fail.”

What Is the Appeal Process for a Denied Workers’ Compensation Claim?

When workers’ compensation insurance denies an initial claim, it’s crucial to ensure that you leave no margin for error in an appeal. The best first step forward is to hire an experienced workers’ compensation lawyer in St. Louis to carefully navigate the process and maximize your chances of a favorable outcome. Then, your attorney will assist you in taking the following steps for appealing a workers’ compensation claim denial:

• File a Request for Review form within 20 days of receiving the notice of denial
• Attend mediation sessions if workers’ compensation doesn’t approve the claim after receiving the review request
• Attend a hearing to present evidence supporting your claim, including medical records, eyewitness statements, and copies of all relevant documents such as accident reports and emails to employers

In many cases, a judge approves the claim after reviewing carefully presented evidence at the hearing. If the judge denies the claim, the next step is to file an appellate claim with the Missouri Labor and Industrial Relations Commission within 20 days of a denial from the commission.

Finally, after a third denial, the final option open to injured workers is to take the case to the Missouri Supreme Court for a review in a final appeal; however, the state supreme court can decide whether or not they wish to hear the case.

How Can a Missouri Workers’ Compensation Lawyer Help?

The best way to approach a workers’ compensation claim is with legal representation from the beginning; however, if you’ve received a denial of your valid claim, it isn’t too late. Contact The Floyd Law Firm, P.C. today to ensure your workers’ compensation appeal meets all deadlines and filing dates.