How & When to Appeal a Workers’ Comp Claim

When a workplace accident keeps you from being able to do your job, you expect Louisiana’s workers’ compensation system to kick in and help support your family during the interim. Unfortunately, it’s not always that simple.

Take Bill, for example. Let’s say Bill works in construction and — like so many others in his line of work — injures his shoulder on the job. Following the Louisiana workers’ comp process to a T, Bill reports the incident to his employer, files his claim within 30 days of its occurrence, and patiently waits for his benefits to come through.

But the benefits don’t show up.

Instead, Bill gets a letter stating that his claim has been denied, leaving him injured without pay and completely unsure of what to do next. Fortunately, Bill has the good sense to set up a free consultation with a local workers’ compensation attorney, during which he learns three useful facts that we’ll share with you here today:

  1. Just how common it is for workers’ comp claims to be denied
  2. Whether that initial claim should have qualified for benefits
  3. How to appeal the denied claim — that is, how to get a second chance at workers’ comp benefits

How Often Is Workers’ Comp Denied in Louisiana?

If Bill’s situation sounds familiar, believe us when we say you’re not alone. According to the Office of Workers’ Compensation Administration (OWCA), 4,397 compensation claims were disputed in Louisiana in 2017 and an average of 4,602 claims were disputed in the four years prior (2013-2016).

While the Louisiana court system does its best to deny only claims that appear fraudulent or erroneous, it’s still rather common for valid claims to be denied. That’s precisely why the appeals process exists: to give injured workers with legitimate claims another shot at getting the benefits they need.

Why Was I Denied Workers’ Comp?

Before diving into the appeals process, let’s do a quick sanity check to make sure you meet Louisiana’s basic requirements for workers’ compensation benefits. Namely:

  • You must meet the basic employee eligibility requirements (outlined in the table below)

Louisiana Employee Eligibility

Eligible

  • Workers who were injured at work or because of work (learn more about specific injuries)
  • Full-time employees
  • Part-time employees
  • Seasonal employees
  • Temporary employees
  • Solo employees
  • Most contract workers

Not Eligible

  • Employees who work in private residential homes
  • Employees who work in unincorporated firms
  • Real estate brokers
  • Musicians and other performers working under contract
  • Certain industrial workers in niche fields
  • Unpaid members of nonprofit organizations

If you’re looking at the above checklist and exclaiming, “I meet all those criteria! My application should have been accepted!” then your next step should be consulting with a local workers’ compensation lawyer. Together, you and your attorney can begin the process of appealing your case.

Can I Still Get Workers’ Comp Benefits?

Using this article to educate yourself about your denied claim was a great first step, but now comes the next one: filing for an appeal. Since your claim has already been denied once (or perhaps more than once), it’s vital that you ensure your case is handled proficiently and correctly from here on out.

If you meet the eligibility requirements outlined above — or even if you’re unsure whether you meet those criteria — I implore you to reach out to The Bruscato Law Firm today. During your free, 25-minute consultation, I will thoroughly evaluate your unique situation to help you better understand why your claim was denied and how best to proceed with the appeals process.


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