What to Expect During the Workers’ Compensation Appeals Process

If your workers’ compensation claim was denied, you’re not alone. Many employees face the frustration of a denied claim after being injured on the job. Fortunately, denial isn’t always the end of the road. You have the right to appeal the decision—and understanding the workers’ compensation appeals process can help you feel more confident as you move forward.

Here’s what to expect and how to prepare for each stage of the appeal.

Step 1: Understand Why Your Claim Was Denied

Before filing an appeal, you need to know the reason for the denial. Some common reasons include:

• Missed deadlines
• Disputes over whether the injury was work-related
• Lack of medical evidence
• Employer or insurer claiming the injury was pre-existing

You should receive a letter outlining the reason for denial. Review this carefully. It will guide your next steps and may also reveal if the issue can be resolved informally—such as by submitting missing paperwork or clarifying medical details.

Step 2: Filing a Formal Appeal

If informal solutions don’t work, you’ll need to file a formal appeal. In Maryland, for example, the appeals process typically begins with a request for a hearing before the Maryland Workers’ Compensation Commission (WCC). You can learn more about the process directly on the Maryland WCC website.

Deadlines are strict. In Maryland, you must file your appeal within 30 days of the date your claim was denied. Missing this deadline can mean losing your right to appeal, so acting quickly is crucial.

Step 3: Preparing for the Hearing

Once your appeal is filed, a hearing date will be scheduled. This hearing functions similarly to a courtroom trial, although it’s less formal. Both you and your employer (or their insurance representative) will have the opportunity to present evidence, call witnesses, and offer testimony.

Here’s what you may need to gather in preparation:

• Medical records related to your injury
• Testimony from your doctor
• Statements from coworkers or supervisors
• Pay stubs or job descriptions
• Any correspondence about your claim

You may also be asked to attend an independent medical exam (IME), which provides another medical opinion on your condition. This report will likely be part of the evidence presented at the hearing.

Step 4: The Hearing

The hearing is overseen by a Workers’ Compensation Commissioner. During the session, each side presents its case. You’ll likely be asked to testify about your injury, how it occurred, and how it has impacted your ability to work.

After reviewing all the evidence, the Commissioner will issue a decision. This usually happens within a few weeks of the hearing.

Step 5: Further Appeals

If you’re unhappy with the Commissioner’s decision, you still have options. You can appeal to the Circuit Court, where your case will receive another level of review. This step is more formal and may require a deeper level of legal strategy and documentation.

Be aware that each stage of appeal has its own deadlines and rules. Missing a filing requirement could put your claim at risk.

Tips for a Smoother Appeals Process

• Stay organized: Keep copies of all medical reports, letters, and forms.
• Meet deadlines: Time limits for appeals are strict and non-negotiable.
• Follow your doctor’s orders: Skipping appointments or ignoring medical advice can hurt your credibility.
• Communicate clearly: Make sure all documentation supports your claim and addresses any issues from the initial denial.

Speak to an Attorney

At Shugarman & Mehring, we’ve helped many injured workers navigate this complex system and get the benefits they need. If your claim was denied and you’re not sure what to do next, feel free to reach out. We’re here to guide you through the process and help you explore your options—without pressure.