What Options Do Federal Workers Have If Their Workers’ Compensation Claim is Denied?
As a federal worker who has been injured on the job, you have the right to seek compensation for your injuries. You’ve filed your claim, and you feel confident about receiving benefits. But then you get word that your claim has been denied. What now? Rest assured that a denial isn’t the end of the road. You can file an appeal and pursue other claim rejection options. Here’s what you need to know.
Why Was Your Claim Denied?
The first step when considering denied claim alternatives is determining why the Office of Workers’ Compensation Programs (OWCP) made this decision. Identifying the specific reason(s) your claim was denied can help you effectively plan your appeal. Here are some common reasons for claim denials:
- Insufficient evidence: One frequent reason for denying a claim is lack of evidence. To be eligible for compensation, you must demonstrate that your injury occurred at work or was directly related to your job duties. It must also not fall into an exclusion category, such as injuries sustained while under the influence, violating workplace safety rules, or committing a crime.
- Incomplete or incorrectly filled out forms: The workers’ compensation claim process is paperwork-intensive. Clerical errors, including incomplete forms or incorrect information, may lead to a denial.
- Failure to promptly report the injury: There are strict deadlines for reporting injuries and filing claims. In general, you have 30 days from the date of injury to report the incident to your superior and file your claim. Missing this deadline may result in a denial.
- Discrepancies in your medical records: If significant differences exist between how you reported the injury and what the medical records indicate, this may raise questions about the validity of your claim.
- Lack of medical evidence: Your claim might be denied if you did not seek prompt medical care for your injury or provide insufficient documentation about the treatment you received.
- Pre-existing conditions: If the injury is deemed a pre-existing condition rather than a work-related incident, the claim may be denied. However, pre-existing conditions worsened by job duties may be considered for coverage.
To have your claim accepted, you must prove five key elements:
- Employment Status – You must be a federal civilian employee.
- Timely Filing – You must submit your claim within the required time limits.
- Fact of Injury – There must be a clear job-related incident or exposure, and you must have a diagnosed medical condition.
- Performance of Duty – Your injury or illness must have occurred while you were performing work-related duties.
- Causal Relationship – There must be a direct connection between your job-related incident or exposure and your diagnosed injury or illness.
Each of these elements must be met for your claim to be approved. If any are missing, your claim may be denied. When a claim is denied the OWCP will issue a formal written decision which should tell you which of these elements were not proven to their satisfaction. The decision will outline your appeal rights, offering you recourse avenues to contest the decision.
Can You Appeal a Federal Workers’ Compensation Claim?
Absolutely, you have the right to file an appeal if your claim is denied. The appeal process gives you a chance to contest the OWCP’s decision. A successful appeal often hinges on presenting new evidence or clarifying previously submitted information, including medical records, expert reports, or documentation related to your employment and the circumstances of your injury.
Appealing a federal workers’ compensation claim often follows these steps:
- Request for reconsideration: One appeal choice is to file a request for reconsideration. This is when you ask the OWCP to reconsider their decision once you submit additional evidence or documentation addressing the reasons for the denial. This request must be received by the OWCP within one year of the date of the original decision.
- Branch of Hearings and Review: Some decisions allow for appeal to the Branch of Hearings and Review (BHR). This can be an oral telephonic hearing, where you present your case, or a review of the written record, where you submit written evidence and arguments. This appeal option must be requested within 30 days of the date of the decision being appealed.
- Employees Compensation Appeals Board: Another option is to escalate your appeal to the Employees’ Compensation Appeals Board (ECAB). The ECAB has the power to change OWCP decisions. Often appeals to ECAB are an appeal of last resort because ECAB will not consider any new evidence. ECAB will only consider evidence that was in the OWCP file before the date of the decision being appealed. A request for this type of appeal must be made within 180 days of the decision being appealed.
The deadlines that apply to each step in the appeal process are very strict. If you fail to meet any, you risk losing your right to appeal. Therefore, you should not wait. Develop an appeal strategy and appeal as soon as practicable.
The Value of Working with a Federal Workers’ Compensation Lawyer
Given the complexity of appealing a federal workers’ compensation claim and the valuable benefits at stake, hiring a lawyer is certainly worthwhile. An experienced federal workers’ compensation attorney can help you navigate the legal system, meet critical deadlines, and present your case in the most effective manner.
Whether you submitted your original claim yourself or with help from another lawyer, Aumiller Lomax would be happy to assist with the appeal process. We understand the frustration of having your compensation claim denied, and we’ll do everything possible to get the denial overturned. Navigating the federal compensation system is our specialty, and we provide free consultations with no upfront fees.
If your workers’ compensation claim has been denied, contact us at 856-751-0440 for help deciding if you should appeal. We’re eager to show you how we can make a difference in your case.