Claim Petitions: What it Means When Your Work Comp Claim is Denied

Under the Minnesota Workers’ Compensation Act, you may be given the false perception that any injury you sustain while in the course and scope of your occupation will be automatically accepted by the employer and/or insurer. Unfortunately, that is false. An insurer will deny a claim if it disagrees with an employee’s claim for workers’ compensation benefits, or there is a dispute as to the nature and extent of benefits payable to an employee. It is atypical for an insurer to reverse their denial without formal litigation. To begin what is essentially an appeal of the insurer’s denial, your attorney will file an Employee’s Claim Petition with the Office of Administrative Hearings, Workers’ Compensation Division. By filing a formal claim petition with the court, you will have the opportunity for your case will be presented to and heard by a workers’ compensation judge who will rule on the disputed issues.

The filing of an Employee’s Claim Petition is completed by your attorney. The petition will outline all benefits claimed, to-date, and may reserve your claims to various other future benefits. With the petition, your attorney will submit copies of any pertinent information to further support your claim to benefits. This information may include but also may not be limited to medical records specific to your claimed injury. Through the filing of the petition, your attorney will also send notification to all third parties that may have a financial interest in the resolution of your claim. Third parties, also known as intervenors, most commonly include medical providers that have provided you care and treatment for your claimed injuries, major medical insurance companies that may have paid medical expenses for your claimed injuries, unemployment and short-term/long-term disability carriers.

Upon receipt of your petition, the employer and insurer will be given a statutory 20-day window to serve and file an answer to the petition. In their answer, a legal representative for the employer and insurer will provide their basis for the denial and may submit any adverse medical reports they have obtained through the course of their initial investigation into your claim. During this phase, defense counsel may notify you and your attorney of their intention to have you undergo an Independent Medical Evaluation (IME).

In the months leading up to your hearing, your case will move through various stages of discovery. Both your attorney and opposing counsel will request and review your medical records. Both attorneys will also review any claims that were previously filed on your behalf with the Workers’ Compensation Division, any relevant personnel records and/or your employment file, wage records and/or tax records, in addition to any relevant disability or retirement files (i.e., social security, PERA, MSRS, etc.). Prior to any hearing, defense counsel will likely require you to provide oral testimony by deposition.

The time between the initial filing of the claim petition and the hearing, The Office of Administrative Hearings will require settlement conferences and pretrial conferences where settlement of the issues will be explored, and the disputes are further clarified. In most cases, the disputed matter will be set for a settlement conference 6-months after the filing of your petition. In special circumstances, your case may be set for an expedited pretrial conference that would likely be scheduled within 30-days to address whether the facts of your case require the hearing to be set for a sooner date. The parties may also use the time prior to hearing to participate in a formal mediation of the disputed claims.

As one can see, the process of appealing your denied claim comes with many layers. It is also entirely possible that your petition could be denied by the courts if you fail to claim your benefits in a timely manner. If you feel your workers’ compensation case was wrongfully denied or you have been improperly compensated, contact Meuser, Yackley & Rowland, P.A. to request a free, confidential consultation with one of our many skilled attorneys for more information on filing your formal claim. Contact us today.