How to Appeal the Denial of a Kentucky Workers’ Compensation Claim

Imagine that you are injured at work in Kentucky and file a claim for workers’ compensation benefits. As far as you are concerned, the injury clearly qualifies for workers’ compensation, so you wait for your notice of approval. However, instead of receiving an approval you are notified that your claim has been denied.

The good news is that you have a right to appeal the denial. The bad news is that the farther you move up the appeals ladder, the harder it becomes to get a claim approved.

Your first step should be to carefully review the notice of denial you received from the Kentucky Department of Workers’ Claims to be sure that you understand the reason for the denial. Common reasons for a denial include:

• Technical issues with the claim. This could be something as simple to correct a failure to include all required documents when you submitted your claim.
• Employer claims you were not “in the scope of employment” at the time of the accident. If there was some question as to whether or not you were “on the job” at the time of the accident, your employer may try to deny the claim on that basis.
• Employer claims the injury/illness was pre-existing. This reason for denial is common when the claim is for an illness or a condition that could be chronic, such as back or neck problems.

Your next stop after the initial denial will be the Benefit Review Conference. Although this is characterized as an “informal” meeting between you and your employer or your employer’s workers’ compensation carrier, don’t be lulled into a false sense of security. A decision about your claim will be made here.

The conference is your opportunity to convince the insurance carrier that you have a valid claim. You may be told that you are not required to bring an attorney. You aren’t required to bring counsel, but the Kentucky Department of Workers’ Claims advises claimants to consult with an attorney prior to the conference. Coming prepared with an attorney by your side often means the difference between getting your claim approved and having to pursue your appeal further.

If you are unable to reach an agreement at the benefit review conference, the next step is a hearing before an administrative law judge. This is a formal hearing where you may present evidence and testimony to support your claim. The judge may also request written briefs in support of your position. The judge will issue a decision within 60 days of the hearing.

If the administrative law judge issues a denial of your claim, you then have 14 days to file a Petition for Reconsideration. In essence, this allows you to point out why you think the judge’s decision was wrong and asks the judge to reconsider the decision.

If the judge affirms the previous decision, you then have 30 days to appeal to the Workers’ Compensation Board. This is a three-member panel that reviews the record from the administrative law judge’s hearing. No new evidence can be submitted to the board. At this level of appeal, the chance of reversing the judge’s decision is slim. The board can affirm the judge’s decision if anything in the record supports it. The board will issue its decision within 60 days.

The final stop in the appeals process is the Kentucky Court of Appeals. Of course, the odds of reversing a denial at this point are low.

The best way to ensure that your injury claim is approved without the need to appeal is to consult an experienced Kentucky workers’ compensation lawyer before you file your original claim.