Appealing a Denied Michigan Workers Compensation Claim

Under the Michigan Workers' Disability Compensation Act, a worker injured in Michigan and covered by the state's workers' compensation system is entitled to workers' compensation benefits. If your workers' compensation claim is denied, first consider whether you should be entitled to workers' compensation benefits. (For more information, see our article on the basics of Michigan workers' comp.)

If you believe you meet these criteria and your workers' compensation claim was still denied, you have the right to appeal, as described below.

Appealing a Denial

To appeal a denial of your workers' compensation claim, you must file an application for hearing with the Michigan Workers' Compensation Agency (Form WC-104A). The form can also be obtained by contacting the Workers' Compensation Agency at (800) 396-5041.

Mediation

Once your application for hearing is received, your case might be scheduled for mediation. You have a right to mediation in any of the following circumstances:

• You are asking for reimbursement for medical treatment only.
• Your claim for benefits is for a set period of time and you have already returned to work.
• You are not represented by an attorney.

The workers' compensation agency might also schedule you for mediation if it believes it would be helpful in your particular case. If your claim is eligible for mediation, your case will be assigned to a mediator, who will try to help you and your employer (or its insurance company) reach a voluntary settlement. Depending on the type of dispute, the mediator might do this over the phone or schedule an in-person mediation hearing.

Trial

If you are unable to resolve the dispute through mediation, you will continue on to a workers' comp hearing (also called a "trial"). The first step in this process is a pretrial hearing. During this hearing, the magistrate (similar to a judge) will review your case, address any preliminary issues, and schedule the case for trial.

Trials are held before the magistrate, not before a jury. At the trial, you and your employer (or its insurance company) will have the opportunity to present medical evidence and other evidence to support your case. This will likely include presenting testimony from your treating doctor(s) and possibly fellow employees that witnessed your work-related injury.

Because a workers' comp trial is a complex legal process, you should strongly consider retaining an attorney to represent you. You will be expected to follow certain procedural rules for submitting evidence, presenting witnesses, and making legal arguments. If you do not have an attorney, you will probably have a difficult time with the process.

After all of the evidence is presented, the magistrate will issue a written decision. You will receive this decision by mail.

Further Appeals

If you disagree with the magistrate's decision, you may appeal to the Michigan Compensation Appellate Commission. The Appellate Commission will typically not hold another hearing. Instead, it will make a decision based on the written transcript of your trial, the magistrate's decision, and written arguments submitted by the parties.

If you're not satisfied with the Appellate Commission's decision, you may appeal through the Michigan state court system. To do so, you must file a complaint with the Michigan Court of Appeals or the Michigan Supreme Court. The state court system has even more complex procedural rules, so you should hire a workers' comp lawyer by this stage, if you haven't already done so.

Benefits During Appeal

If the magistrate rules in your favor at trial, and your employer (or its insurance company) appeals the decision, you will still receive 70% of the workers' compensation benefits ordered while the appeal is pending. If you eventually win your appeal, you will receive the rest of your workers' compensation benefits. If your employer wins the appeal, you will not be required to repay any of the benefits you received.