Wrongful Denial of Workers’ Compensation Claim in Rapid City
Appealing a Denied Workers’ Compensation Claim in South Dakota
If your employer carries workers’ compensation insurance and you are injured at work or while carrying out any duties or activities related to your employment, you can file a workers’ compensation claim and seek medical and wage replacement benefits. Unfortunately, however, many workers’ compensation claims are wrongfully denied.
If you believe your workers’ compensation claim was wrongfully denied, reach out to our Rapid City workers’ compensation lawyers right away for help. You have the option of appealing a denied claim, but it is incredibly important that you work with a qualified attorney who can help guide you through this process. At Beardsley, Jensen & Lee, we bring over 100 years of combined experience to every case; we can help ensure that you do not miss any important deadlines or make any mistakes that could affect your claim.
Learn more about how our firm can help you with your workers’ compensation appeal by calling us at (605) 250-1242. Your initial consultation is free.
Why Are Workers’ Compensation Claims Denied?
Workers’ compensation claims are denied for myriad reasons, ranging from claimant eligibility issues to mistakes on applications. In some cases, claims are denied on valid grounds, but in others, they are wrongfully denied simply because an employer or insurance company does not wish to pay out claims.
Your workers’ compensation claim may have been denied for any of the following reasons:
- Failure to Report: By law, you must notify your employer in writing about your work-related injury or illness within three days to file a workers’ compensation claim. If you fail to report your injury, you could lose your ability to bring a workers’ compensation claim.
- Injury Disputes: Your employer may argue that your injury or illness was not work-related, or they may dispute the severity of your injury/illness, thereby affecting your benefits. This often occurs when an injury is unwitnessed, meaning no one saw what happened.
- Liability/Eligibility Issues: Your employer may argue that they are not liable or that you are not eligible for workers’ compensation benefits because you were acting outside of company policy and/or the law, or that you were somehow negligent, leading to your injury/illness.
- Discrepancies in Your Report/Medical Records: If there are any discrepancies between your initial accident/injury report and your medical records, your employer or the insurance company may dispute or deny your claim.
- You Waited to File Your Claim: In some cases, waiting too long to file your claim could hurt you. If you miss the state’s statute of limitations on workers’ compensation claims, you will not be able to file a claim. In other cases, the insurance company may dispute claims that are filed long after the accident/injury occurred—even when the statute of limitations has not expired.
- You Refused to Give a Statement: While you are NOT legally required to provide a statement to the insurance company (nor should you, as this can actually hurt your claim), the insurance company may use your refusal as grounds to deny your claim. The same is true if you decline to sign medical authorizations which, again, you are NOT legally required or obligated to do.
If your workers’ compensation claim has been denied, regardless of the reason, you should contact an experienced Rapid City workers’ compensation lawyer at our firm to discuss your various options. Beardsley, Jensen & Lee can help you determine if you are eligible to appeal the denial and, if so, can guide you through each stage of the process.
How the Appeals Process Works
Appealing a denied workers’ compensation claim in South Dakota is a complicated, time-consuming process. We strongly encourage you to work with an attorney from the moment you receive official notice that your claim has been denied. Remember, Beardsley, Jensen & Lee provides legal services on a contingency fee basis, meaning you do not owe any upfront or out-of-pocket fees, and we only get paid if we secure compensation for you.
Below, we’ve provided a brief overview of the South Dakota workers’ compensation appeals process:
- The first thing you should do after receiving notice that your claim has been denied (or that your benefits have been terminated) is contact the insurance company. The insurance company can detail why your claim was denied, whether due to an error on your application, incomplete information, or another reason.
- If you believe your claim was wrongfully denied, you can submit a written request for mediation. You must submit your request to the South Dakota Department of Labor and Regulations (DLR). During mediation, a DLR representative works with both sides (you and the insurance company) with the goal of reaching a settlement agreement. We strongly recommend that you work with an attorney who can help protect your rights during mediation and beyond.
- If mediation is unsuccessful, or if you do not wish to go through mediation, you can petition the DLR for a hearing. You must file your petition for a hearing within two years of the date on which you received official notice that your claim was denied. The hearing is held before an administrative law judge, or ALJ, who hears evidence from both sides and decides whether to uphold the claim denial or reverse it and grant benefits.
- If you do not agree with the ALJ’s decision, you have the option to request a review by the DLR. You must submit your request for a review in writing within 10 days of receiving the ALJ’s decision via mail. The DLR may either grant or deny your request; in rare cases, they may decide to review additional evidence.
- If your request for review is denied, or if you do not wish to request a review of the ALJ’s decision by the DLR, but you are still unhappy with the ALJ’s decision, you can file an appeal in the South Dakota Circuit Court. At this point, if you have not yet hired an attorney, it is critical that you do so. Navigating the court system is very complicated; having an experienced attorney by your side can make a huge difference in the outcome of your case.
Please keep in mind that every situation is different, and every case is unique. While this provides an overarching view of the workers’ compensation appeals process in South Dakota, various factors may affect how your case proceeds.
Why Work with Beardsley, Jensen & Lee?
The South Dakota workers’ compensation system is very complex. Simply filing an initial claim for benefits can be very challenging, regardless of whether you are seeking temporary total disability or permanent partial or total disability.
When you put our Rapid City workers’ compensation lawyers on your side, you don’t just get one attorney—you get an entire team of dedicated and experienced legal professionals who are ready to pool their resources, skills, and knowledge to build a powerful case on your behalf. We understand the importance of recovering your rightful benefits and are prepared to help you navigate the appeals process as quickly and cost-effectively as possible.
Our team is compassionate and accessible when it comes to being there for our clients—but we are aggressive and unrelenting when it comes to taking on employers and insurance companies that seek to unjustly deny our clients’ rightful claims. We develop personalized strategies aimed at achieving each client’s unique goals, all while fighting to ensure your rights are protected every step of the way.