If you’ve suffered a work-related injury or illness in Washington, D.C., you’re entitled to benefits through the workers’ comp system, including medical expenses and payments for part of your lost wages. But what if your employer’s insurance company denies your claim or only approves partial benefits? This article explains common reasons insurers deny workers’ comp claims and how to file an appeal with the D.C. Office of Workers’ Compensation (OWC).
Notify your employer immediately if you are injured on the job, and seek medical treatment as soon as possible. Your claim is more likely to be denied if you delay reporting the injury or seeking treatment.
In order to begin the claims process, you must also submit two official forms to your employer and the OWC. File an Employee’s Notice of Accidental Injury or Occupational Disease (Form 7) within 30 days of the injury, and an Employee’s Claim Application (Form 7A) within one year of the injury. Your claim might be denied if you don’t meet these deadlines. (For more details, see How to File a Workers’ Compensation Claim in the District of Columbia.)
Workers’ comp in D.C. only covers occupational diseases and accidental injuries “arising out of and in the course of employment” (AOE/COE), a legal term for injuries that happen because of the job and while the employee is actually working. Disputes over claims often hinge on the AOE/COE requirement. For example, your injury won’t be considered job-related if:
You also can’t receive workers’ comp benefits in D.C. if you’re already receiving benefits for the same injury under the workers’ comp system in any state (outside of D.C.).
These are only some of the reasons your claim could be denied. See Denied Workers Compensation Claims to learn more about other common reasons insurers deny claims.
You have the right to appeal if the insurer denies your claim or doesn’t award the benefits that you requested. The OWC resolves claim disputes in D.C. There are three stages to the appeal process:
The workers’ comp appeals process can be complicated and requires detailed knowledge of D.C. law, the Office of Workers’ Compensation, and the D.C. court system. If you haven’t already done so, you should consider consulting with an experienced workers’ comp attorney who can guide you through this process and protect your rights. Learn more about when you need to hire a lawyer for your workers' comp case and what a good workers’ comp attorney should do for you.