If you have suffered a workplace accident or illness in Michigan you may be entitled to benefits from the Michigan workers’ compensation system. In theory, filing for benefits and getting that application approved should be easy. In reality, however, navigating the workers’ compensation system can be difficult, particularly if your original claim for benefits is denied. It is always in your best interests to consult with an experienced Michigan workers ‘compensation attorney to discuss the specifics of your case; however, a basic understanding of what happens if a workers’ compensation claim is denied in Michigan may be helpful in the meantime.
If you are injured on the job, or believe you are suffering a job related illness, you should report your injury or illness to your employer immediately. Typically, your employer then files a claim for benefits with the employer’s workers’ compensation insurance carrier. If your employer does not file a claim for you it may become necessary to file one yourself with the Michigan Workers’ Compensation Agency. Shortly after your claim is filed you should receive either an approval or a denial. A claim may be denied for a number of reasons, including, but not limited to:
- Employer claims you are not a covered worker
- Employer claims your injury/illness is not job related
- Employer claims it is a pre-existing condition
- Employer claims the illness/injury is not covered
- Technicalities (insufficient information, form missing etc.)
If you receive a Notice of Denial you have the right to appeal the denial. To do so you must notify the Agency of your intention to appeal. Some appeals go directly to mediation, including the following:
- Your claim concerns a definite period of time and you have returned to work.
- Your claim is for medical benefits only.
- You are not represented by an attorney.
- The Agency determines that the dispute may be resolved by mediation.
Claims that do not meet the above criteria will go directly to the Michigan Workers’ Compensation Appellate Commission, or MWAC. In addition, if you went through mediation and do not agree with the decisions reached during mediation you may also appeal to the MWAC. At the MWAC stage your case will be heard by a magistrate, someone who is similar to a judge. A trial will occur during which you may present evidence in support of your claim for benefits. Likewise, your employer will present evidence in support of the denial of benefits. If the magistrate upholds the denial, you then have the right to appeal to the Michigan Court of Appeals and the Michigan Supreme Court.
Getting a claim approved becomes more difficult the farther you climb up the appeals ladder. For this reason, it is best to consult with an experienced Michigan workers’ compensation attorney early on in the process.
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