do you appeal a decision?

Just wondering if, when you get a decision from your workers' compensation bureau denying a claim, you appeal it on behalf of the employee. We do not appeal a denial since the bureau addresses their denial letter to the employee and copies us. We feel that it is the responsibility of the employee to submit their appeal in writing to the bureau. If we can assist the employee by providing any information we will do that but we will not appeal on their behalf. What do others do?


  • 11 Comments sorted by Votes Date Added
  • this a trick question mushroom HR? We never file an appeal on the employees behalf. If the claim is denied - we make sure the employee informs their doctor & help with ensuring their illness/injury is covered by our health insurance. My advice - don't get into the business of appealing claims on the employee's behalf - it's counterintuitive to your business and sets bad precedence.
  • No, this wasn't a trick question. I agree with what you say however, management in my company thinks I should help out the employee and do whatever is needed to get their claim allowed. They just don't understand that when a claim is allowed it costs the company beaucoup $$. Thanks for your response mwild31. I appreciate you agreeing with me.
  • If you need more ammunition, I agree with you as well.
  • Add to that, for a few employees, if they could get something for nothing (I would never accuse anyone of submitting a false claim or overstating the illness) they would. Why help them?
  • If it's management at your company pushing for the denial - is it because the injured employee is somehow related to management? This is so bizare to me - that management would willingly set themselves up for a claim - what's their angle? Do they know something you don't?
  • Your management does not understand that worker's comp claims cost them money? WHAT????????????????????
  • Ditto to the above. I would not engage in helping an employee file an appeal after a denial of W/C.
  • [font size="1" color="#FF0000"]LAST EDITED ON 11-05-03 AT 08:05PM (CST)[/font][p]The former HR Director in our shop looked at WC as a benefit and always tried to help the ees get full utilization of their benefits. She was so successful that our claims (both frequency and dollars) went through the roof! When renewal time rolled around we were cancelled by our carrier and forced into the 'insurance pool' plus our experience rating went from .90 to 1.24 over the space of 2 years. Currently our premiums are 500% higher than they were before the attitude that WC was a benefit. This HR director even went with the ees to their hearings to help them get their full claims allowed. What a nightmare.

    We get to deal with the increased cost for 3 years while all of these claims keep our experience rating high and other financial penalties continue to hit our premiums for WC.

    That is one way management can be misinformed about WC. Needless to say, we have made some changes in this area.
  • The employee (not the employer) was denied the claim. You might make sure your employee understands the decision and that if he needs info to let you know and you will do what you can. However, this is DEFINITELY the employees responsibility (unless there was some gross misunderstanding that you or one of your employees conveyed during the investigation.) I work with and sort of "oversee" our employees on W/C but I don't get involved with reversal of decisions. That is their business. I am sure you have other things to do.
    E Wart
  • Do nothing. They will be notified by the division of WC on the denial, their rights etc.
    Hey Marc, I hope one of your changes was firing the HR Director who actively worked to get claims accepted, geez what a moron. If it is legit, we want the employee taken care of, if it is questionable, it is our job to protect the companies assets.
    My $0.02 worth.
    DJ The Balloonman
  • She was not fired, but was put into another area directing some programs. She is a very good director, took on the HR hat when others did not even recognize the need. Overall did a great job, but did not really understand the workings of WC.
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