What If My Workers Compensation
Claim Is Denied?
Kansas overhauled its workers compensation system in 2011 with the passage of the Kansas Workers Compensation Act (KWCA), which tilted the system in favor of employers and their insurance companies. Deadlines for filing were tightened, and qualifications for benefits were suddenly contingent upon the injury or illness sustained at work being deemed the “prevailing factor.”
Subsequent to the KWCA, the state adopted the 6th Edition of the “Guides to the Evaluation of Permanent Impairment” published by the American Medical Association (AMA). This revised edition, which replaced the then-in-use 4th edition, curtailed physician discretion in determining the level of a worker’s impairment. This further stacked the odds against workers and their claims.
Not surprisingly, in light of these statutory and regulatory changes, workers are facing more rejections and adverse or limited-benefit decisions. In Fiscal Year 2021, ending September 30, 2021, the Kansas Department of Labor in its annual report lists 13,382 “judicial filings” as arising from a total of 44,507 injury claims.
Judicial filings include worker actions such as “application for review and modification of a decision,” “request for a preliminary hearing,” and “request for an independent review.” In other words, almost 30 percent of those injured found reason to challenge the workers compensation benefit decision they had received.
The workers compensation attorneys at Slape & Howard have been fighting for changes to the KWCA and overall improvement in the statewide system for more than a decade now. We proudly represent clients throughout the state who are making initial claims or are fighting adverse decisions, as we work with other legal groups to press the legislature for change.
If you have a workers compensation claim, or need to file an appeal of a decision, contact us immediately. Our office is in Wichita, Kansas, but we are active throughout the state in helping employees receive what is owed to them under the workers compensation system.
Reasons Your Claim May Be Denied
Under the KWCA, your claim for benefits can be denied if it is determined that the accident or incident at work that you claim to have caused your injury or illness is not the “prevailing factor.” Another reason could be that you failed to meet the filing deadline, which initially stands at 20 days after your injury.
The KWCA also requires that your injury occurred during “the course and scope” of your employment. This means if your injury occurred during a break or during your commute to or from work, you won’t be covered. The KWCA also excludes conditions that result from the natural aging process or from the normal activities of daily living.
Appealing a Denial or Partial Award of Benefits
Once your employer and insurer turn down your claim, the next step is to file an Application for a Preliminary Hearing before an administrative law judge (ALJ). Hearings are currently being held either remotely or in person, depending on where you live in the state.
The initial, or pre-trial, hearing will be fairly informal, with both you and your employer being allowed to present evidence and testimony. After that, a full hearing will be scheduled if you and your employer cannot agree on a resolution.
A full hearing is more like a trial in that you can introduce both witnesses and evidence, and the other side can “cross-examine.” If at the full hearing, the ALJ rules against you, your next step is to file for a review by the Appeals Board. You have 10 days after the ALJ ruling to file for an appeal.
In establishing the board, Kansas Statute 44-555(a) explained:
“The board shall have exclusive jurisdiction to review all decisions, findings, orders, and awards of compensation of administrative law judges under the workers compensation act. The review by the appeals board shall be upon questions of law and fact as presented and shown by a transcript of the evidence and the proceedings as presented had and introduced before the administrative law judge.”
The appeals board functions much like an appellate court. You will be required to file a brief, setting forth your evidence and arguments. The board can then order the employee and employer into mediation, or it can hold a full hearing.
Much like the options before an appellate court, the board, after a hearing, can agree or disagree with the ALJ’s decision and then award or deny you compensation, or adjust your compensation as it sees fit. It can also send the matter back to the ALJ for reconsideration.
Legal Guidance You Can Trust
Going before an administrative law judge to argue your right to benefits for your injury or work-related illness is not something the average employee has the background and training for. You definitely will need an experienced workers compensation attorney to guide and represent you.
Better yet, to avoid having to request ALJ or Appeals Board hearings, rely on legal guidance from the beginning when you file your initial claim. The success, partial success, or outright failure in obtaining the benefits you need and deserve often springs from the medical documentation and other evidence you submit upon initially applying for workers compensation.
If you need to file a workers compensation claim – or appeal a decision – rely on the attorneys at Wichita-based Slape & Howard. We will help you navigate the system and provide the representation you need when a review or appeals hearing looms before you. Reach out immediately. Let us advocate for you and your rights.