8. What happens in the case of a denied workers' compensation claim?
Within 30 days of receiving your Form 18, the insurance carrier must make a decision as to whether it will "accept" or "deny" your claim. In some cases, the carrier will accept your claim on a "medical benefits-only basis," or "conditionally accept" your claim for a limited, investigatory period--without foregoing the right to later deny the claim. The answers to the questions above are generally applicable to "accepted" claims.
However, even if the insurance carrier "denies" your claim, you may be entitled to benefits under the Workers' Compensation Act. Pursuing these benefits will require you to challenge the carrier's denial and prove that your injury or condition is "compensable." If your claim is denied, it will likely be helpful to speak with an attorney about your chances of successfully challenging the denial. If an attorney agrees to represent you, he or she will file a Form 33 to request a hearing before the Industrial Commission. This Request for Hearing is not a formal "lawsuit," but serves a similar purpose.
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