If your workers’ comp claim has been denied, or you disagree with the amount of your benefits, you can dispute the decision with the North Dakota Workforce Safety & Insurance (WSI). The appeals process is outlined below. For an overview of eligibility and benefits, see our article on filing a North Dakota workers’ comp claim.
In North Dakota, employers are required to have workers’ comp insurance through Workforce Safety & Insurance (WSI). Once you give notice of your injury to your employer, it will submit a report with WSI. WSI will then decide whether to accept your claim and will issue a Notice of Decision.
If you are not satisfied with the decision, you can submit a written request for reconsideration with WSI within 30 days of the mailing date on the notice. Your request must explain why you believe the original decision was wrong. If you fail to submit your request within 30 days, the original decision becomes final.
After receiving a request for reconsideration, WSI will either issue a new award or send you an administrative order upholding its original decision. If you receive an administrative order you can ask the Decision Review Office (DRO) for assistance resolving the dispute. The DRO acts independently of WSI’s claim division and provides free dispute resolution services to injured workers. A DRO specialist will review your case, answer question about the workers’ comp process, explain the grounds for WSI’s decision, and identify possible solutions. The specialist is required to keep your communications confidential.
The DRO specialist will contact WSI’s claim division to try to settle the dispute. WSI will decide whether to uphold the original decision, change it according to your request, or offer some alternative. At the end of the process, you will receive a certificate of completion explaining the outcome.
While you’re not required to work with the DRO, there are financial incentives for doing so. If you eventually win your case on appeal, WSI will pay your attorneys’ fees—but only if you participated in the DRO process and made a good faith effort to resolve the dispute informally.
If you’re not able to resolve the dispute through the DRO, or you decide to skip that step, you can file a request for an administrative hearing. To do so, you must submit a letter explaining why you believe WSI’s decision was wrong within 30 days of the mailing date on the administrative order (or within 30 days of the certificate of completion, if you sought help from the DRO).
Once WSI receives your request, it will assign an administrative law judge (ALJ) to hear your case and notify you of the time and location of your hearing. Depending on WSI’s caseload and the complexity of your case, it could take weeks or even months for your hearing to be scheduled. WSI will also assign an attorney to your case. This attorney represents WSI’s interests, not yours. If your case is going to a hearing, you should find your own lawyer to represent you.
During the hearing, the ALJ will hear from both sides, review evidence submitted by the parties, and make a decision. The decision is typically mailed within 30 days of the hearing.
If you are not satisfied with the ALJ’s decision after the hearing, you can appeal to the North Dakota District Court in the county where you live or where your injury happened. You must file your appeal with the court within 30 days of the mailing date on the ALJ’s order. A judge will review your case and written briefs from the parties, but generally will not receive additional evidence.
If you disagree with the district court judge’s order, your final appeal is with the North Dakota Supreme Court. You must file your appeal in writing within 60 days of the district court judge’s order.
Complicated procedural rules apply to any case brought in civil court, including appeals of workers’ compensation denials. If you haven’t already, you should consult with a workers’ comp attorney before filing an appeal in court.