Can You Appeal a Denied Workers' Compensation Claim in Arkansas?

Experiencing a workplace injury can be a life-changing event. Workers’ compensation exists to provide much-needed financial support and medical coverage for employees injured on the job. However, when a workers' compensation claim is denied, it can leave injured workers feeling uncertain about how to proceed. Fortunately, in Arkansas, you have the right to appeal a denied claim, ensuring you still have a chance to secure the benefits you deserve. This blog outlines the steps involved in appealing a denied claim, common reasons for denials, and how you can strengthen your case.

Why Workers' Compensation Claims Are Denied

Understanding the reasons for a claim denial is a critical first step in preparing an appeal. Common reasons include:

Missed Deadlines

Arkansas law requires workers to report their injury to their employer within a set timeframe, typically 30 days. Additionally, filing the workers' compensation claim itself must be done promptly. Failing to meet these deadlines is one of the most common reasons claims are denied.

Lack of Documentation

A successful workers' compensation claim relies on clear and detailed documentation of the injury and its connection to your workplace. Missing medical records, inadequate descriptions of the incident, or insufficient evidence tying the injury to your job can all lead to a denial.

Disputed Injury Claims

Employers or insurance companies may dispute whether your injury occurred at work or question its severity. For example, if there were no witnesses or if the injury developed gradually (such as repetitive strain injuries), the insurer may argue that it is not work-related.

Pre-Existing Conditions

Another common reason for denial is the existence of a pre-existing condition. If the insurance company believes your injury was caused by a health issue unrelated to work, they may deny your claim. However, if your job aggravated or worsened a pre-existing condition, you may still be eligible for compensation.

Non-Compliance with Treatment

Failing to follow prescribed medical treatments or missing appointments can be used as grounds for denial. The insurer may argue that you are not taking the necessary steps to recover, which can negatively impact your case.

The Appeals Process in Arkansas

If your workers’ compensation claim is denied, Arkansas provides a structured process for appealing the decision. Here’s how you can pursue an appeal:

1. Review the Denial Letter

When your claim is denied, you will receive a written notice explaining the reasons for the decision. Carefully review this letter to understand the specific issues cited. This information will guide your approach during the appeal process.

2. File a Petition for Hearing

To formally contest the denial, you must file a Petition for Hearing with the Arkansas Workers’ Compensation Commission (AWCC). This document requests a review of your claim by an administrative law judge. The petition must be filed within the appropriate timeframe to avoid forfeiting your right to appeal. Consulting an attorney at this stage can help ensure your paperwork is accurate and complete.

3. Collect Additional Evidence

To strengthen your appeal, gather any evidence that supports your case. This may include:

• Detailed medical records outlining your diagnosis and treatment
• Statements from coworkers or witnesses who observed the incident
• Expert testimony from healthcare providers linking your injury to your job
• Proof of lost wages or other financial impacts resulting from the injury

Comprehensive evidence is key to addressing the reasons for the initial denial and building a convincing argument.

4. Attend the Hearing

The AWCC will schedule a hearing where both you and the insurance company will present your cases. This is your opportunity to provide evidence, call witnesses, and make your argument before the administrative law judge. Having an experienced attorney represent you during the hearing can significantly improve your chances of success.

5. Appeal Further Decisions

If the administrative law judge rules against you, you can request a review by the full Arkansas Workers’ Compensation Commission. Should this also result in an unfavorable decision, you have the option to take your case to the Arkansas Court of Appeals. Each level of appeal requires careful preparation and adherence to deadlines.

How to Strengthen Your Appeal

Success during the appeals process often depends on preparation and strategy. Here are some tips for strengthening your appeal:

Act Quickly

Meeting deadlines is essential. Delays in filing your appeal or submitting additional evidence can jeopardize your case.

Be Thorough

Ensure your evidence is complete, well-organized, and directly addresses the reasons for denial. Gaps in documentation or missing records can weaken your case.

Seek Expert Testimony

Statements from medical professionals, vocational experts, or other specialists can provide critical support for your claims, particularly when addressing disputed injuries or pre-existing conditions.

Work with an Attorney

Navigating the appeals process can be complex, and the insurance company will likely have legal representation. An experienced workers' compensation attorney can help you understand your rights, prepare your case, and advocate on your behalf.

The Role of an Attorney in the Appeals Process

Appealing a denied workers’ compensation claim can feel overwhelming, especially when dealing with legal and procedural requirements. An attorney can provide valuable assistance by:

• Reviewing the denial letter and identifying weaknesses in the insurer’s argument
• Gathering and organizing evidence to support your case
• Preparing you for the hearing and representing you before the AWCC
• Negotiating with the insurance company to resolve disputes

Having skilled legal representation ensures that your appeal is handled effectively and increases the likelihood of a favorable outcome.

What Happens If Your Appeal Is Successful?

If your appeal is successful, you may be entitled to receive the benefits originally denied. These benefits could include:

• Coverage for medical expenses related to your injury
• Wage replacement benefits during your recovery
• Compensation for permanent disability, if applicable
• Rehabilitation services to help you return to work

Securing these benefits can provide much-needed financial relief and support during your recovery.

Call Walker Law Group Today if You’ve Been Injured at Work

A denied workers’ compensation claim in Arkansas can be a significant setback, but it does not mean the end of your case. By understanding the reasons for denial, following the proper appeals process, and seeking legal assistance, you can fight for the benefits you deserve. If your claim has been denied, contact Walker Law Group. Our experienced team is dedicated to helping injured workers pursue their appeals and secure the compensation they need to move forward with confidence.