Was your workers’ comp claim denied in Oregon? If so, you’re not alone. 

There are ways to fight back and get the compensation you deserve. We often get calls about workers’ comp claims that have been denied. These calls usually come from workers who were legitimately injured at work or engaged in a work-related activity and have been wrongfully denied.

Workers’ compensation insurance companies like SAIF, Liberty, Sedgwick, and Hartford deny claims for a variety of reasons. The law in Oregon and other states is complicated, and many workers who rightly deserve workers’ comp are denied.

But your interests are worth fighting for, and we’re here to help you get the compensation you need and deserve.Your interests are worth fighting for. Below, we’ll explain some of the reasons for denied workers’ comp claims and the steps to take after a workers’ comp denial so you can move forward confidently.

Why Workers’ Comp Claims May Be Denied

The workers’ compensation claims process can be complicated, and claims are denied for all sorts of reasons. Here are some of the most common reasons workers’ comp claims are denied:

• The injury was not reported on time.
• The claim was not filed on time.
• The employer disputed the claim.
• The injury is not compensable.
• The employee did not seek medical treatment.
• There is insufficient evidence that the injury occurred.

Understanding the reasons for denied workers’ comp claims is the first step in preparing your appeal.

Read More: 9 Common Defenses Against Workers’ Compensation Claims

Steps To Take After Workers’ Comp Claim Denial

Just because your claim was denied doesn’t mean you’re out of luck. You can still fight for the benefits you deserve by requesting a hearing to contest the denial. Below are the steps to take after a workers’ comp denial.

Step 1: Review Your Denial Letter

Start by carefully reviewing the denial letter from the insurance company. It should explain why your claim was denied, such as late reporting, medical evidence issues, or an employer dispute. Make note of the date you received it as deadlines to appeal start from that day.

Step 2: File a Request for Hearing

If you’re wondering how to appeal denied workers’ comp, the process starts here. In Oregon, you have 60 days from the date on your denial letter to request a hearing with the Oregon Workers’ Compensation Board (WCB). This is your opportunity to formally challenge the decision. To do this, complete and submit a Request for Reconsideration form.

Step 3: Gather Medical Evidence

Next, collect all medical records related to your injury, including doctor’s notes, test results, and imaging scans. Ask your doctor to provide a written opinion linking your injury directly to your work activity. Strong medical evidence is essential, especially if the insurer argues your condition was preexisting.

Related: How to Prepare for Workers’ Comp Doctor Evaluation

Step 4: Prepare Witness Testimony

If coworkers, supervisors, or others saw your injury happen, their testimony can support your account. At your hearing, both you and your witnesses may be asked to testify under oath to establish how and when the injury occurred.

Step 5: Consider Free Help

Oregon provides a free Ombuds Office for Oregon Workers that helps injured workers navigate claim denials. The Ombuds can explain the process, help you understand your rights, and assist with filing paperwork.

Step 6: Work With an Attorney

While you can represent yourself, hiring an experienced workers’ compensation lawyer, like the ones at RGMR, greatly improves your chances of success. Attorneys know how to present medical evidence, cross-examine insurance doctors, and argue effectively before a judge. In Oregon, workers’ comp lawyers do not charge upfront fees and you only pay them if you win.

Step 7: Attend Your Hearing

Finally, attend your hearing before an administrative law judge, where evidence and testimony will be reviewed. The insurer’s lawyer and doctors may argue against your claim, so preparation is critical. If the judge rules in your favor, you’ll receive the benefits you were denied. If not, you can appeal to the WCB’s Board Review Division within 30 days.

Related: What To Do After You Get a Work Injury in Oregon

When You Should Hire a Workers’ Comp Lawyer

If your workers’ compensation claim has been denied, it’s time to speak with an attorney. Workers who hire a lawyer after a denial are far more likely to secure a hearing and win their appeal.

Find a lawyer who focuses on workers’ compensation because they understand the process inside and out. They know the strategies insurers use to deny benefits, and know what judges look for when deciding these cases. That experience can make the difference between losing benefits and getting the support you need.

Also choose an attorney who practices locally and works exclusively with injured workers. Some lawyers represent both employees and employers, but that can create divided loyalties. You deserve someone whose only focus is protecting your rights and fighting for your recovery.

FAQs About Workers’ Comp Denial

How do I appeal a denied workers’ comp claim in Oregon?

If your claim is denied, you can appeal by filing a Request for Hearing with the Oregon Workers’ Compensation Board within 60 days of receiving your denial letter. At the hearing, you’ll need to prove that your injury happened on the job and that it is the primary cause of your medical needs or disability. Many workers choose to hire an attorney to strengthen their case.

How long do I have to appeal a denied workers’ comp claim?

In most cases, you have 60 days from the date you receive your denial letter to request a hearing. In rare situations, you may be given up to 180 days if you can show “good cause” for missing the deadline. Check what the deadline is in your state.

Do I need a lawyer to appeal a denied claim?

You are not required to have a lawyer, but many workers who win their appeals do so with legal representation. 

Will I still have medical coverage if my workers’ comp claim is denied?

If your workers’ comp claim is denied, the insurer will usually stop paying for your medical care related to the injury. This means you may need to rely on your personal health insurance or pay out of pocket until the denial is overturned on appeal. If your appeal is successful, the workers’ compensation insurer may be required to reimburse you and your health plan for treatment costs.

Get Professional Workers’ Comp Appeal Help With RGMR

If you were injured at work and your claim was denied, don’t give up. At Ransom, Gilbertson, Martin, & Ratliff, LLP, we have devoted our careers to fighting for the rights of injured and mistreated workers. We’re committed to understanding the circumstances of your case and working directly with you to make the best argument possible to ensure you get the benefits you need that were denied to you.

We don’t charge fees, and you don’t pay anything unless we win your case. Contact us today to get a free consultation so we can fight for your interests.