Yes, Des Moines workers may fight back if an insurer denies their workers’ compensation claims and they disagree with the decision. The first step for any worker facing a workers’ comp dispute is to calmly and honestly try to work out the dispute with the employer and/or the employer's insurance company.
Hearing with Iowa Workers’ Compensation Commissioner
If the worker and insurance company cannot resolve the dispute, the worker can request a hearing with the Iowa Workers’ Compensation Commissioner (IWCC). A Deputy Workers’ Compensation Commissioner (Administrative Law Judge, or ALJ) will hear arguments from both sides about the claim and issue a ruling.
The Deputy Commissioner will examine the evidence in the case and may ask for arguments from the attorneys. The injured worker may testify regarding the case, and others may testify as well. The Deputy Commissioner will rule on administrative laws and codes. Each party may submit a brief to the ALJ to explain their positions.
Workers unsatisfied with the Deputy Commissioner's ruling can appeal to the Iowa Workers’ Compensation Commissioner. The Commissioner may then review the evidence and make the agency’s final decision.
At this point, the parties may submit briefs but will generally not submit any additional evidence. Workers often hire an attorney to represent them in hearings with a Deputy Commissioner and when appealing to the IWCC.
Appealing a Case Beyond the IWCC
Workers may appeal to the judicial review process where Iowa courts can make decisions regarding how the law is applied. Appeals may go to Iowa district courts, appellate courts, and even the Iowa Supreme Court. Rarely, the case might be remanded back for a new hearing or to consider other evidence.
Using an attorney during the judicial review process is important to ensure you follow the correct procedures and to argue the case after the IWCC final ruling.
Why do insurance companies deny workers’ compensation claims?
There are valid reasons to deny workman’s compensation claims including:
- lack of evidence;
- violation of law or policy; and
- expiration of the statute of limitations.
If the employee was intoxicated or intentionally caused the injury, it may give the insurer grounds to deny benefits. Insurance companies also have invalid reasons to deny claims, though, and unfortunately some will deny claims or reduce benefits without just reason.
Insurers may simply wish to reduce the amount they have to pay. They might blame injuries on pre-existing conditions or argue that the injury is not actually work-related. This may be the case in repetitive motion injuries that lack a single obvious event that could have caused the injury.
What protections do workers have when fighting for their claims?
Workers cannot be fired for pursuing workers’ compensation claims, and employers cannot punish other employees for supporting a worker's claim. Also, in any future job interviews, employers cannot consider past workers’ compensation claims as a factor in whether to hire the individual. Speak with an attorney if any of these problems arise.
Walker, Billingsley & Bair can help Des Moines workers prepare appeals of their workers’ compensation denials and will answer any questions about the process. Contact our office at 888-435-9886 to schedule a consultation with an attorney.