Appealing a Denial of Your Indiana Workers’ Compensation Claim
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 Indiana Workers’ Compensation Board. (For an overview of eligibility and benefits, see our article on filing an Indiana workers’ comp claim.)
Getting Help from the Ombudsman Division
For workers who haven’t received any benefits, or whose benefits have been terminated by the insurance company, the Ombudsman Division of the Workers’ Compensation Board offers assistance. Once you file a Request for Assistance form with the Ombudsman Division, it will investigate your complaint and contact the insurer to try to help you reach an informal resolution.
In many cases, workers’ compensation benefits are terminated because your treating physician has declared that you’re able to return to work. If you disagree, the Ombudsman Division will provide you with information on how to request an independent medical examination for a second opinion. (To learn more, see our article on independent medical examinations.)
For more information, contact the Ombudsman Division at (317) 232-3808 or (800) 824-2667.
Filing an Appeal
If the Ombudsman Division isn’t able to assist you, you can file an appeal with the Workers’ Compensation Board. To file your appeal, you must complete an Application for Adjustment of Claim form. You must complete and sign the form and deliver the original and four copies to the following address:
Indiana Workers’ Compensation Board
402 W. Washington St., Rm. W196
Indianapolis, IN 46204-2753
In general, you must file your workers’ compensation claim within two years of the date of your injury. However, to avoid any negative impact on your claim, the best practice is to file your appeal as soon as possible. Once the Workers’ Compensation Board receives your appeal, it will schedule an in-person hearing before a workers’ comp judge.
The Ombudsman Division has a voluntary mediation program to help workers and insurers reach informal resolutions of their disputes. If both parties agree to participate, the Division will schedule a mediation before a neutral third party mediator. The mediator will hear from both sides and try to help the parties reach a settlement. The mediator does not, however, make a decision on your dispute. If you and the insurer can’t reach an agreement, you will continue on to the hearing.
If you’re interest in participating, you must submit a written request to the Ombudsman Division. The Division will then contact the insurer and inform you if the insurer agrees to participate. For more information, contact the Ombudsman Division.
The Workers’ Compensation Hearing
The appeal hearing will take place in the county where you were injured, the county where your employer is located, or another nearby county. Workers’ compensation hearings typically last at least a few hours, but can be several hours depending on how complex the issue is 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 Full Workers’ Compensation Board. To do so, you must file an Application for Review by the Full Board form within 30 days. The Board will review the evidence presented at the initial hearing and make a decision. In most cases, the Board will not hear new evidence unless there are special circumstances that prevented you from submitting the evidence at the initial hearing.
If you’re not satisfied with the Board’s decision, you may file an appeal with the Indiana Court of Appeals.
Hiring an Attorney
To find an experienced workers’ compensation attorney in your area, see Nolo’s online lawyer directory.