A workplace injury can leave you facing medical bills, lost wages, and uncertainty about when you can return to work. Receiving a workers’ compensation denial can make an already difficult situation even more stressful.
However, a denied Michigan workers’ compensation claim does not necessarily mean you are ineligible for benefits. Insurance companies may dispute claims for several reasons, and injured employees have the right to challenge those decisions.
Understanding why your claim was denied and how Michigan’s dispute process works can help you determine your next steps.
Why Are Workers’ Compensation Claims Denied in Michigan?
Michigan workers’ compensation generally provides benefits for qualifying injuries and occupational diseases arising out of and in the course of employment.
However, employers and insurance companies may dispute whether a particular condition qualifies.
Common reasons for denial include:
- Disagreement over whether the injury occurred at work
- Claims that a medical condition existed before the workplace incident
- Insufficient medical evidence connecting the injury to employment
- Disputes about disability or the employee’s ability to work
- Alleged failures to provide timely notice or pursue benefits within applicable deadlines
A denial may involve the entire claim or only certain benefits, such as wage-loss payments or medical treatment.
Identifying the insurer’s specific reason for denying benefits is an important first step.
Review the Denial and Gather Supporting Evidence
If your claim is denied, request or retain any written explanation provided by the employer or insurance company.
Review the stated reason carefully. A disagreement about medical causation requires different evidence than a dispute over wages or employment status.
Useful records may include accident reports, medical records, work restrictions, witness statements, and communications with your employer.
You should also preserve pay stubs and employment records if your claim involves lost wages.
The goal is to establish what happened, how the injury relates to your work, and how it affects your ability to earn wages.
Continue Following Appropriate Medical Advice
A workers’ compensation denial does not make your injury disappear.
Continue obtaining medically appropriate care and following reasonable treatment recommendations. If you have work restrictions, make sure they are clearly documented.
Medical records may become critical evidence if the insurer argues that your condition is unrelated to work or that you can return to your previous duties.
Avoid assuming that a denial automatically resolves questions about treatment authorization or payment responsibility. Those issues may need to be addressed separately while the dispute continues.
How Do You Appeal a Michigan Workers’ Compensation Denial?
In Michigan, disputed workers’ compensation claims are generally handled through the Workers’ Disability Compensation Agency.
An injured employee may file an Application for Mediation or Hearing to seek a determination of disputed benefits.
Depending on the circumstances, the case may proceed through mediation or a hearing before a workers’ compensation magistrate.
Both sides may present medical records, testimony, employment information, and other relevant evidence.
If the magistrate issues an unfavorable decision, additional review may be available through the Workers’ Compensation Appellate Commission, subject to applicable procedures and deadlines.
The process is more formal than simply asking an insurance adjuster to reconsider.
How Long Do You Have to Act?
Michigan workers’ compensation law includes important notice and claim deadlines.
Generally, employees must provide notice of a workplace injury within 90 days and make a claim for compensation within two years, although exceptions and additional rules may apply.
Different deadlines can govern appeals from formal decisions.
Because the applicable timeline depends on the circumstances, injured employees should not delay seeking advice after receiving a denial.
Waiting may make it harder to preserve evidence or protect the right to benefits.
Why Legal Guidance Matters
Disputed workers’ compensation cases can involve complicated questions about medical causation, disability, wage-earning capacity, and procedural requirements.
Duff Law can help Michigan employees review denial reasons, gather medical and employment evidence, pursue disputed benefits, and navigate hearings or appeals when necessary.
Legal guidance may be particularly important when an insurer disputes a serious injury or stops benefits while an employee remains unable to work.