What if My Workers’ Compensation Claim Is Denied?

If your workers’ compensation claim is denied, you still have options. In many cases, a denial is just the beginning of the appeals process, not the end of your right to benefits. While it’s understandably frustrating to receive a denial after suffering a work-related injury or illness, it’s important to know that you’re not alone, and legal remedies exist to help you fight for the support you deserve.

Whether your claim was denied due to missing paperwork, a dispute with your employer, or a lack of medical evidence, you may still be able to secure benefits through a formal appeal. In this article, we’ll walk you through the common reasons for denial, what steps to take next, and how legal support from a Colorado workers’ compensation lawyer can help with your case.

Why Are Workers’ Compensation Claims Typically Denied?

Getting a denial letter can be discouraging, especially when you’re dealing with pain, medical bills, and missed work. However, understanding why your claim was denied is the first step toward turning things around. Here are some of the most common reasons:

• Missed Deadlines: Workers’ compensation laws in Colorado require you to report your injury within 10 days. Missing this deadline can result in an automatic denial.
• Incomplete or Incorrect Paperwork: Errors on forms, missing documentation, or forgetting to submit required medical records can all lead to a claim being denied.
• Employer Disputing the Injury: If your employer argues that your injury didn’t happen at work or wasn’t work-related, the insurance company may reject your claim.
• Lack of Medical Evidence: A claim may be denied if there’s not enough medical proof that your injury is real or serious enough to require time off or treatment.
• Pre-Existing Conditions: If the insurance company believes your injury is due to a condition you had before your job, they might deny your claim, even if work aggravated it.

What Should You Do Immediately After a Denial?

If your workers’ compensation claim is denied, don’t panic and don’t give up. A denial doesn’t mean you aren’t entitled to benefits. It simply means you may need to take additional steps to get your claim approved.

Read the Denial Letter Carefully

The denial letter should explain why your claim was rejected. Look for specific details, such as:

• The date of the decision
• The reason for denial (e.g., late reporting, insufficient evidence)
• Instructions for appealing the decision

Keep a copy of the letter in a safe place; you’ll need it during the appeals process.

Identify and Understand the Reason

Once you know the reason for the denial, you can decide how to move forward. Some issues can be fixed quickly, like submitting missing documents, while others may require a formal appeal.

Consider Talking to a Colorado Workers’ Comp Attorney Early

Even if you haven’t decided to hire a lawyer yet, a quick consultation can help you understand your rights, deadlines, and options. We offer free case consultations to let you know your legal options.

Can You Appeal a Workers’ Compensation Denial?

Yes, you absolutely can appeal a denied workers’ compensation claim. Appealing is a common and necessary step when a claim is rejected, especially when the denial is based on a technical issue or dispute that can be clarified.

How the Workers’ Compensation Appeals Process Generally Works

The appeals process is handled by two Colorado agencies: the Division of Workers’ Compensation and the Office of Administrative Courts (OAC). Here is an overview of how appeals usually work in Colorado:

File a Petition to Review

In Colorado, there is no ‘reconsideration’ step like in some states. Instead, if you disagree with the insurance company’s decision, you must file something called an Application for Hearing. This means you’re officially requesting that your case be reviewed by the Office of Administrative Courts (OAC), a specialized court for workers’ compensation cases. You must file this request within 45 days of receiving your denial notice.

Prepare and Submit Supporting Documentation

Once the hearing is scheduled, both sides, the injured worker and the insurance carrier, will have an opportunity to gather and submit evidence, which may include:

• Medical records
• Testimony from doctors or vocational experts
• Witness statements
• Employment or accident reports

A Prehearing Conference or Settlement Conference may be scheduled to resolve disputes before a full hearing.

Attend the Administrative Hearing

The hearing will be conducted by an Administrative Law Judge (ALJ) at the OAC. During the hearing, each side presents evidence and questions witnesses. The ALJ does not represent either party and is responsible for issuing an impartial ruling based on the facts and the law.

Receive the Administrative Law Judge’s Decision

After the hearing, the ALJ will issue a written decision, usually within a few weeks. The decision will either uphold the denial or order the insurer to pay benefits. If you disagree with the outcome, you can file a Petition to Review with the Industrial Claim Appeals Panel within 20 days.

Should You Hire a Workers’ Compensation Attorney?

While you are legally allowed to represent yourself, the appeals process is often complex to handle alone, especially when you’re dealing with medical issues, financial stress, and insurance company pushback.

How a Lawyer Can Help

Workers’ compensation lawyers understand the system inside and out. They can:

• Analyze the denial letter and identify legal grounds for appeal
• Help gather and organize critical medical evidence
• Represent you during hearings and negotiate with insurers
• Ensure you meet deadlines and file paperwork correctly
• Present your case clearly and persuasively before a judge

In many cases, denials result from technical errors, missing information, or disputes that can be resolved effectively with legal support.

How Fees Work

Our Colorado workers’ compensation lawyers work on a contingency fee basis, meaning they only get paid if you win your case. 

When to Contact an Attorney

It’s best to contact an attorney as soon as you receive the denial. Early involvement means your lawyer can build a stronger case and avoid costly mistakes during the appeal. 

Contact a Colorado Workers’ Compensation Lawyer

A denied workers’ compensation claim can feel overwhelming, but it’s not the end of the road. Many claims are denied for reasons that can be corrected or challenged through the appeals process. Whether your denial was due to a paperwork issue, lack of evidence, or a dispute over how the injury occurred, you have the right to fight back.

Understanding why your claim was denied, taking swift action, and seeking professional guidance can make all the difference. With the right approach, many injured workers can reverse a denial and secure the medical care and wage benefits they need to recover.

At Matlin Injury Law, our Colorado workers’ compensation attorneys are here to help you take the next step with confidence. If your claim has been denied, contact us for a free consultation. We’ll review your case, explain your options, and fight to get you the compensation you deserve.