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When Should I Appeal an Alabama Workers’ Compensation Denial?

Posted on September 10, 2018

The Alabama Department of Labor denying your workers’ compensation claim doesn’t necessarily mean the end of your recovery journey. There may be other outlets to obtain financial compensation for your workplace accident. You generally have two ways to resolve a workers’ compensation case dispute involving a claim denial. One is to challenge the decision through a lawsuit. The other is to appeal to the Alabama Department of Industrial Relations (DIR). Work with a local attorney for your best odds of successfully appealing the Department’s decision.

About Workers’ Comp Appeals in Alabama

Alabama is unique when it comes to appealing the Alabama Department of Labor’s workers’ compensation decision. Most states have a court process available to hear workers’ compensation disputes. Alabama does not. Instead, employees in Alabama have to file lawsuits in a state court to appeal a workers’ comp claim decision. For this reason, it’s best to hire an attorney to represent your case. A lawyer can improve your odds of a successful appeal. Here’s how the typical process might look:

  1. You receive notice of a claim denial. The Department must state its reason for denying your claim. Common reasons include failure to notify your supervisor of the accident in time, insufficient proof that the injury happened at work, and a claim that the injuries were self-inflicted. Sometimes, denials result from administrative errors.
  2. You request help from the DIR. You can either file a lawsuit to contest your denial in Alabama, or you can request assistance from the DIR. The DIR route is appropriate if you only need to appeal a medical benefit denial. Submit your dispute to a DIR mediator who can conduct a conference on the matter. This is the DIR’s Ombudsman Program. Note that the DIR does not have the authority to decide on disputes that don’t relate to medical treatment, unless the insurance company agrees to participate in mediation.
  3. You file a lawsuit. If the Ombudsman Program isn’t right for your appeal, you’ll file a civil lawsuit with an Alabama District Court. This might be the only option if the insurance company refuses mediation – a likely outcome after a claim denial. File your claim in the district where your workplace accident happened. Your claim must summarize the details of your complaint and list the benefits you seek. Hire a lawyer for assistance with lawsuit filing.

If you file a lawsuit for wrongful workers’ compensation claim denial, the next phase is the discovery process. You and the insurance company will have a chance to gather evidence supporting your claims. Then, you and your attorneys will present your case before a judge, who will listen to both sides and reach a verdict. A lawyer is a major asset to have by your side during a civil case against a workers’ comp insurance company in Alabama.

When Is an Appeal the Right Move?

Filing an appeal in the form of DIR assistance or a civil lawsuit might be the right move for you if you believe the insurance company wrongfully denied your workers’ compensation claim. If you sustained your injuries while performing work-related tasks, followed all the rules for timely accident reporting, saw an approved physician, and filed your claim on time, you should generally qualify for workers’ comp benefits. An unexpected denial may be grounds for an appeal.

Appealing a workers’ compensation decision can be difficult in Alabama. You must navigate the civil claims process or a DIR mediation, using detailed knowledge about the state’s system. Use a lawyer to optimize your odds of a successful appeal. If you believe you deserve medical benefits and lost income compensation after a work-related injury, don’t hesitate to contact a Birmingham personal injury lawyer. An appeal can be the best way to secure the compensation.