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Denied claim? Here’s what to expect during the appeals process

On Behalf of | Feb 5, 2025 | Workers' Compensation

Workers’ compensation is a state-mandated insurance program that offers benefits to employees who suffer work-related injuries or illnesses. In Rhode Island, this program covers medical expenses, rehabilitation costs, and a portion of lost wages. It ensures workers receive the necessary support without proving employer negligence, allowing them to focus on recovery and return to work.

Potential reasons for the denial

Several factors can lead to a denied workers’ comp claim. Understanding these reasons can help you navigate the process more effectively:

  • Incomplete documentation: Missing or incorrect paperwork can result in denial.
  • Delayed reporting: Failing to report the injury promptly to your employer can jeopardize your claim.
  • Non-work-related injury: If the injury or illness is not directly related to your job, the claim may face a denial.
  • Disputed injury: Employers may dispute the severity or validity of the claim.
  • Violation of workplace policies: Injuries that occur while you are under the influence of drugs or alcohol, or if they result from a policy violation, may not receive coverage.

What happens during the appeals process?

If your claim gets denied, you have the right to appeal. Understanding the appeals process can make it more manageable:

  • File a petition: Submit a Petition for Trial to the Rhode Island Workers’ Compensation Court within the specified timeframe.
  • Gather evidence: Collect medical records, accident reports, and witness statements to support your case.
  • Attend mediation: Participate in a mediation session to resolve disputes before proceeding to trial.
  • Prepare for trial: If mediation fails, prepare for a formal hearing where a judge will review the evidence and decide.

Expect the appeals process to take time and require detailed documentation. Stay organized and consider consulting an attorney to strengthen your case.

Moving forward with confidence

Facing a denied workers’ comp claim can be daunting, but understanding the appeals process empowers you to take the necessary steps. With the proper preparation and support, you can navigate the system and work toward securing the benefits you deserve. Stay informed and proactive throughout the journey to maximize your chances of a successful appeal.