How do I appeal a workers’ compensation decision that I do not agree with?

In Delaware, employees who are injured on the job are often entitled to workers' compensation benefits for medical expenses and wages lost by being unable to work during their recovery. However, in some cases, the injured worker's claim may be denied, or the employer and employee may be unable to reach an agreement on what benefits are owed.

For someone injured in the workplace, a workers' compensation claim denial can be confusing, frustrating, and maybe even a little frightening. Fortunately, a denied claim or inability to come to an agreement with an employer is not the end of the line. Injured employees can appeal a denied workers' compensation claim through the Delaware Office of Workers' Compensation if necessary.

If you are considering appealing a workers' compensation claim denial for a workplace, here's what you need to know.

Common Reasons for Workers' Comp Claim Denials

There are a number of reasons why an injured or ill employee's workers' compensation claim is denied. Some of the most common reasons for workers' compensation claim denials include:

  • The injury occurred while the employee was off duty or not performing work-related tasks.
  • The employee was under the influence of alcohol or illegal drugs when he was injured.
  • The employer believes that the injury or illness was preexisting, or was caused by factors unrelated to the claimant's employment.
  • The injury happened while the employee was roughhousing or engaged in a personal, non-work-related dispute with another worker.
  • The employee failed to immediately report his injury to an employer.

While some of these factors may result in a legitimate denial of a workers' compensation claim, sometimes a claim is denied simply in the hope that the injured employee will not pursue it. Before accepting a workers' compensation claim denial, it is best to consult an experienced workers' compensation attorney.

Appealing a Decision Through the Delaware Office of Workers' Compensation

After receiving notification that a claim has been denied—or after being unable to reach an agreement with an employer regarding workers' compensation benefits—the injured worker can file a Petition to Determine Compensation Due with the Delaware Office of Workers' Compensation to begin the appeals process. This petition must be filed within two years of the on-the-job injury.

Next, both parties file a pre-trial memorandum with the Office of Workers' Compensation and attend a pre-trial scheduling conference. Finally, the parties present their cases during a hearing before the Industrial Affairs Board (IAB) in which both sides introduce evidence and question witnesses. The IAB will issue its final written decision, approving or denying the claim.

Appealing a Decision Through the Court System

Sometimes, the decision the IAB issues is not the one the injured worker was hoping to receive. Fortunately, the claimant's options are not yet exhausted. The employee, in certain circumstances, can still appeal the decision through the court system.

After receiving notice that the claim was denied by the IAB, the injured worker has 30 days to appeal the decision to the Superior Court located in the county where the injury occurred. If the Superior Court also denies the claim, the claimant has 30 days to file an appeal with the State Supreme Court. The injured worker must take into account that the court system reviews IAB decisions to determine if substantial evidence exists in the record to support the IAB’s findings of fact and to determine if the Board erred in its application of the law. Because of this heightened legal standard, an experienced workers’ compensation attorney can be particularly beneficial in analyzing the facts in an injured worker’s case and determine the likelihood of success of an appeal before incurring costly court fees.

Do You Need a Workers' Compensation Attorney?

If you were injured on the job, the experienced attorneys with the Morris James Personal Injury Group can help you fight for the workers' compensation benefits you deserve. Contact the Morris James Personal Injury Group today to schedule an appointment for a free initial consultation to discuss the details of your case.