What to Do If Your Workers' Compensation Claim Is Denied in North Dakota

Learn why you might be turned down for workers' comp benefits in North Dakota and how you can appeal.

If you were hurt at work or became ill because of your job, it could be discouraging if you learn that your claim for workers’ comp benefits has been turned down. But that doesn’t have to be the end of the story: You have the right to challenge a decision by North Dakota Workforce Safety & Insurance (WSI), the agency that reviews and pays out workers’ comp claims in the state. This article explains common reasons the WSI denies claims and how you can appeal a denial.

Common Reasons Workers’ Comp Claims are Denied

North Dakota compensates employees for work-related injuries and illnesses. Specifically, the injury must arise “out of and in the course of hazardous employment,” which essentially means that it both happened on the job and was caused by work activities or conditions. Your claim will be denied if your injury doesn’t meet both of those requirements and if you don’t have objective medical evidence to support your claim. State law spells out some types of injuries that are not covered, including:

  • ordinary diseases that the general public is exposed to, like colds or the flu
  • intentionally self-inflicted injuries
  • injury caused by the employee’s illegal actions or use of alcohol or illegal drugs
  • mental (psychological) conditions that result from job-related stress or something other than a work-related physical injury
  • injuries that result from a fight the employee started
  • preexisting conditions, and
  • injuries that happen while the employee is participating in a voluntary, unpaid recreational activity like a company picnic or softball game.

The WSI may also deny your claim if you don’t report your injury to your employer within seven days, or if the official claim form isn’t filed with the WSI within one year after the injury. Your employer will usually file the form, but you can and should do it yourself if your employer doesn’t follow through. (See How to File a Workers’ Compensation Claim in North Dakota for more details on filing requirements and Denied Workers’ Compensation Claims to learn about other common reasons that can derail your claim.)

After your claim is filed, WSI will mail you a notice of its decision.

The Administrative Appeals Process

If the WSI denies your claim or if you disagree with the benefits amount, you may challenge that decision through a multistep administrative process for resolving workers’ comp disputes:

Reconsideration

First, you may ask the WSI to reconsider its decision by submitting a written reconsideration request within 30 days after the WSI mailed its notice of decision. Your request should include an explanation of why you think the decision was wrong. If you don’t meet the 30-day deadline, the original decision becomes final. The WSI will issue an administrative order either reversing its decision or upholding it.

Dispute Resolution with the Decision Review Office

If the WSI upholds the original decision, you may request free assistance from the Decision Review Office (DRO) within 30 days. The DRO (which is independent of the WSI claims department) will review your claim to see if anything might justify changing the decision. A DRO specialist will also communicate with the WSI on your behalf and try to reach a resolution. At the end of the process, the DRO will send you a certificate of completion explaining the results.

This step is optional: You don’t have to work with the DRO. But if you do, and you eventually win your case after going through more appeals steps, the WSI will pay your legal fees.

Administrative Hearing

After reconsideration (and the DRO process, if you’ve gone through that), you may appeal the WSI’s decision by requesting a hearing and explaining what you think is wrong with the decision. You must submit your written request within 30 days after the mailing date of the administrative order or the DRO’s certificate of completion. An independent administrative law judge (ALJ) will notify you of the hearing time and location. At the hearing, both sides can present evidence, including testimony from witnesses.(Learn more about what to expect at your workers' comp hearing.) The ALJ will usually mail the decision within 30 days after the hearing.

Court Appeals

If you disagree with the ALJ’s decision, you may then appeal to the North Dakota District Court in the county where you live or where the injury happened. You must file the appeal within 30 days after the mailing date on the ALJ order. After reviewing the case, the district court judge will issue a decision. If you don’t like that decision, your final option is to appeal to the North Dakota Supreme Court within 60 days of the district court’s order.

Reach Out to a Lawyer

The workers’ comp appeals process in North Dakota can be complicated and difficult to navigate, particularly once you get to the administrative hearing and court appeals. An experienced workers’ comp attorney can explain the legal procedures involved, help you prepare evidence to support your claim, and guide you through this process. To learn more about how legal representation can help you win your case, see our article What a Good Workers’ Comp Lawyer Should Do for You.) And as discussed above, you may be able to get the state to pay your attorney’s fees if you've used the DRO's assistance. (For more about legal fees, see How Much Workers’ Comp Lawyers Cost in North Dakota.)

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