Appealing a D.C. Workers' Compensation Denial
Learn how to challenge a denial of your workers' comp benefits in D.C.
If your workers’ comp claim has been denied, or you have a dispute with the insurance company about your benefits, you can file an appeal with the District of Columbia Administrative Hearings Division. (For an overview of eligibility and benefits, see our article on filing a D.C. workers’ comp claim.)
If your workers’ comp claim has been denied, you may request an informal conference before a claims examiner by filing an Application for Informal/Mediation Conference with the Office of Workers’ Compensation. You and the insurance company will meet for an conference, and the claims examiner will hear from both sides. The process is very informal, and the claims examiner will issue a written recommendation within 30 days of the conference. The recommendation is not binding, though, if either party contests it and requests a formal hearing. If neither party requests a formal hearing within the time limits set forth in the decision, the recommendation will become binding.
Requesting a Formal Hearing
Instead of requesting an informal conference, you can also immediately request a formal hearing before a workers’ comp judge. To file your appeal, you must complete an Application for Formal Hearing, attach a copy of your workers’ comp claim form, and sign the document to verify that everything you have provided is accurate. You must file the form with the Administrative Hearings Division (AHD) and deliver it to the following address:
Office of Hearings and Adjudication
Administrative Hearings Division
4058 Minnesota Avenue, NE Suite 4400
Washington, DC 20019
Phone: (202) 671-2233
Once the AHD receives your request, it will schedule an in-person hearing before a workers’ comp judge and send notice to the parties. Hearings are typically scheduled within 90 days.
The Workers’ Compensation Hearing
The appeal hearing will take place at the Office of Hearings and Adjudication. Workers’ compensation hearings typically last at least a few hours, but can be several hours depending on the complexity of the issues or how much evidence there is to present.
During the hearing, each party will have the opportunity to question witnesses, submit documents, and make legal arguments. A workers’ comp judge will preside over the hearing and mail a written decision to the parties.
Although workers’ compensation hearings are less formal than court proceedings, there are still procedural rules that must be followed. And, in most cases, your employer will have a lawyer representing its interests. To avoid being at a disadvantage, you should consult with a workers’ compensation attorney to represent you. In most cases, you won’t have to pay for attorneys’ fees out of pocket. Workers’ comp attorneys typically work on a contingency fee basis, which means that they take a percentage of anything recovered on your behalf.
If you disagree with the judge’s decision, you may appeal to the Compensation Review Board. To do so, you must file an Application for Review within 30 days. The Board will review the evidence presented at the initial hearing and make a decision. For questions, and for the Application for Review form, contact the Compensation Review Board at (202) 671-1394.
If you’re not satisfied with the Board’s decision, you may file an appeal with the D.C. Court of Appeals within 30 days.
Hiring an Attorney
To find an experienced workers’ compensation attorney in your area, see Nolo’s online lawyer directory.