If your Kentucky workers’ compensation claim is denied, you have a right to appeal that denial. Your claim might be denied if your employer's workers' comp insurance company says your injury isn't covered, that you are not a covered employee, or that your injury isn't related to a workplace accident.
The first step is to review the notice you received stating your claim was denied. (You should receive written notification of the denial within a couple months of filing a claim with the Kentucky Department of Workers’ Claims.) The letter will detail the appeal process.
You may want to contact your employer’s workers’ compensation insurance carrier to determine the reason(s) your claim was denied. If it was a simple paperwork issue, you may be able to clear the issue and move on with your claim relatively quickly.
After your claim is one file with the Department of Workers’ Compensation, you will receive notice of the date, time, and place of your Benefit Review Conference. This is an informal conference involving you and your employer’s workers’ compensation insurance carrier to define the issues and discuss a settlement. You should plan on bringing medical documentation to support your claim.
If you are unable to reach an agreement at the Benefit Review Conference, your case will be assigned a hearing date.
At the hearing, an Administrative Law Judge (ALJ) will preside. If possible, you should have an attorney represent you at the hearing because the process is a complex, sophisticated legal hearing.
At the hearing you should present evidence of your workers’ compensation claim, including testimony from your doctor and any eyewitnesses of your work-related accident. The Administrative Law Judge will review the evidence submitted by you and by your employer. After the hearing, the judge may ask both parties to submit written briefs, and the judge will then issue a written decision within 60 days of the hearing.
You have 14 days from the date of the judge’s decision to request a “Petition for Reconsideration.” In this type of appeal, you simply ask the ALJ to reconsider. Your Petition for Reconsideration should list the reason(s) you believe the Administrative Law Judge’s decision is incorrect, and the evidence to support those reason(s). The judge will then issue a new decision, affirming, reversing, or modifying the prior decision.
You may appeal the Administrative Law Judge’s final decision to the Workers’ Compensation Board. This appeal must be filed within 30 days of the Judge’s final decision.
The three-member Kentucky Workers’ Compensation Board will not review any new evidence; instead, the board will review only the evidence submitted during the hearing. The chance that the board will change the Administrative Law Judge’s decision is low – if there is any evidence to support the judge’s decision, the Board is required to affirm the judge’s decision.
The Board will issue a written decision within 60 days of the last appeal brief being filed.
Either party may then appeal the board’s decision to the Kentucky Court of Appeals. The Court of Appeals defers to the board, however, and will only reverse the board’s decision in rare cases involving significant legal issues.