A denial letter can feel like the end of the road. It is not. Indiana law gives you the right to appeal and pursue the benefits you may be owed.
Why claims get denied
Insurance companies deny claims for several common reasons. Knowing the cause helps you build a stronger response. Claims are often denied for the following reasons:
- Missed reporting deadline: You must report your injury to your employer within 30 days.
- Disputed work connection: The insurer argues the injury did not happen on the job.
- Pre-existing condition: The insurer attributes your injury to a prior health issue.
- Insufficient medical records: Your documentation does not clearly link the injury to your job.
Review your denial letter closely. It must state the reason for the denial and explain your appeal rights.
Filing an appeal with the Indiana Workers’ Compensation Board
To challenge a denial, you must file an Application for Adjustment of Claim with the Indiana Workers’ Compensation Board. Under IC 22-3-3-3, you have two years from the date of injury to file. If benefits were paid at some point, the deadline runs two years from the last payment date. Missing this window can permanently bar your claim.
Once filed, your case is assigned to a hearing member. The Board may schedule an informal conference, offer mediation or proceed to a formal hearing.
How to strengthen your appeal
Strong evidence is the foundation of a successful appeal. The goal is to directly address the reason stated in your denial letter. Useful evidence includes:
- Medical records: Documentation that connects your injury to specific job duties.
- Witness statements: Accounts from coworkers who saw the accident or hazardous conditions.
- Accident reports: Written records showing how and where the injury occurred.
- Second medical opinion: An evaluation from a doctor you choose, not the insurer’s physician.
Gather this material as soon as possible. Delays can limit what is available.
You may speak with an attorney about your next steps
The appeals process involves deadlines, hearings and rules that can be difficult to navigate on your own. An attorney can review your denial, advise you on the strength of your case and represent you before the Board. Speaking with a workers’ compensation lawyer may clarify how Indiana’s appeal rules apply to your situation.