- | By Steele & Ferguson, P.C.
If your workers’ compensation claim is denied in Michigan, you still have the right to challenge the denial and pursue medical treatment, lost-wage benefits, and other compensation. A denial does not automatically end your case. You may need to file Form WC-104A, the Application for Mediation or Hearing, with the Michigan Workers’ Disability Compensation Agency. Your case may then proceed through mediation, a pretrial conference, negotiations, or a hearing before a Michigan workers’ compensation magistrate.
Can I Appeal a Denied Workers’ Comp Claim in Michigan?
Yes. You can challenge a denied Michigan workers’ compensation claim.
The process is not always a traditional “appeal” immediately after the insurance company denies your claim. In most cases, the injured worker begins a formal dispute by filing Form WC-104A, Application for Mediation or Hearing.
After the Michigan Workers’ Disability Compensation Agency receives the application, the agency serves the appropriate parties and schedules the case for a pretrial conference with a workers’ compensation magistrate. Certain cases may be sent to mediation first to determine whether the dispute can be resolved without a full hearing.
Do not assume the insurance company made the final decision. An employer or insurance carrier can deny your claim, but a Michigan workers’ compensation magistrate can ultimately decide whether you are entitled to benefits.
Why Was My Michigan Workers’ Compensation Claim Denied?
A Michigan workers’ compensation insurance company may deny a claim because it disputes whether the injury is work-related, whether you are disabled, or whether you followed the required procedures.
Common reasons for workers’ comp denials include:
- The insurance company claims the injury did not happen at work.
- Your employer disputes that the accident occurred.
- You did not report the injury promptly.
- Your medical records do not clearly connect the condition to your job.
- The insurer claims you had a pre-existing condition.
- The insurance company argues that work did not cause or significantly aggravate the condition.
- Your doctor’s records do not document clear work restrictions.
- The insurer claims you can return to work.
- There are inconsistencies between your accident report, medical records, and statements.
- You missed an appointment or insurance medical examination.
- The employer failed to properly report the claim.
- The insurer claims you are an independent contractor rather than an employee.
- The insurance company argues that you have not suffered a loss of wage-earning capacity.
Michigan generally requires an injured worker seeking wage-loss benefits to establish that the work-related disability caused a loss of wage-earning capacity in work suitable to the worker’s qualifications and training.
A denial based on one of these arguments does not necessarily mean the insurance company is correct.
What Should I Do After My Workers’ Comp Claim Is Denied?
Take the following steps immediately:
- Read the denial carefully.
Determine exactly why the employer or insurance company denied the claim. Do not rely only on what an adjuster told you over the phone. - Keep the denial letter and all correspondence.
Save emails, letters, claim forms, text messages, medical records, work restrictions, accident reports, and insurance documents. - Continue receiving necessary medical treatment.
Follow your doctor’s instructions and attend scheduled appointments. Gaps in treatment may be used to argue that your injury is not serious or is no longer disabling. - Tell every medical provider that the injury is work-related.
Your medical records should accurately explain when the injury occurred, how it happened, and how your job caused or aggravated the condition. - Follow all medical restrictions.
Do not perform work that violates your restrictions. At the same time, do not refuse work that your doctor has properly approved without obtaining legal advice. - Document your lost wages.
Keep pay stubs, tax documents, schedules, overtime records, attendance records, and information about any second job. - Identify witnesses.
Write down the names and contact information of coworkers, supervisors, customers, or others who saw the accident or observed your condition afterward. - Prepare a detailed timeline.
Record the date of injury, when you reported it, who received the report, when you obtained treatment, when you stopped working, and when the denial arrived. - Do not give a recorded statement without understanding the risks.
What you say may later be compared with your medical records, accident report, and testimony. - Speak with a Michigan workers’ compensation lawyer.
An attorney can identify why the claim was denied, obtain supporting evidence, file the proper documents, and represent you before the Michigan Workers’ Disability Compensation Agency.
How Do I Challenge a Workers’ Comp Denial in Michigan?
A denied worker may need to complete and file Form WC-104A, Application for Mediation or Hearing.
Michigan currently requires the form to be completed, printed, signed, and properly submitted. An unsigned or incorrectly completed application may be returned.
The general process may include:
- Filing the WC-104A application.
- Serving the employer and insurance carrier.
- Receiving a hearing date and case information.
- Attending a pretrial conference before a magistrate.
- Exchanging medical records and other evidence.
- Participating in mediation or settlement negotiations.
- Taking depositions from doctors or other witnesses.
- Proceeding to trial before a workers’ compensation magistrate when the dispute cannot be resolved.
- Receiving the magistrate’s decision.
- Filing an appeal when legally appropriate.
Only Michigan workers’ compensation magistrates can hear disputed cases after an application for hearing has been filed with the agency. There are no jury trials in the Michigan workers’ compensation administrative system.
What Evidence Can Help Overturn a Workers’ Comp Denial?
Strong evidence may include:
- Emergency room and urgent care records
- Medical records from treating doctors
- Diagnostic testing, including MRIs, X-rays, and CT scans
- Written medical restrictions
- A doctor’s opinion connecting the condition to your employment
- Accident reports
- Photographs or videos of the accident scene
- Workplace surveillance footage
- Witness statements
- Emails or text messages reporting the injury
- Timecards and attendance records
- Pay stubs and wage documentation
- Job descriptions
- Safety reports
- Prior medical records addressing a disputed pre-existing condition
- Evidence showing that work aggravated or accelerated an existing condition
The evidence needed depends on the insurer’s reason for denying the claim. A causation denial requires a different response than a denial based on late notice, employee status, disability, or wage loss.
What Benefits Can I Recover After a Denied Claim?
A successful Michigan workers’ compensation claim may provide:
- Reasonable and necessary medical treatment
- Wage-loss benefits
- Partial wage-loss benefits
- Vocational rehabilitation
- Reimbursement for qualifying medical travel
- Specific-loss benefits for certain permanent losses
- Death benefits for qualifying dependents
- A potential workers’ compensation settlement
Michigan’s system provides medical, wage-replacement, and rehabilitation benefits for qualifying work-related injuries. Medical benefits should generally be available beginning on the date of injury, while wage-loss benefits are subject to a waiting period.
If your wage loss lasts more than seven consecutive days, benefits may begin on the eighth day. If the disability continues for 14 days or longer, benefits may also become payable for the first seven days. Weekly benefits are generally calculated at approximately 80% of the worker’s after-tax average weekly wage, subject to Michigan’s statutory calculations and maximums.
Can Workers’ Comp Deny My Medical Treatment?
Yes. An insurance carrier may dispute whether treatment is reasonable, necessary, or related to the work injury.
Michigan law generally requires an employer to provide reasonable medical, surgical, hospital, and other qualifying treatment needed for a work-related injury. During the first 28 days of treatment, the employer ordinarily has the right to select the doctor. After 28 days, the worker may change doctors after notifying the employer and insurance company, preferably in writing.
A denial involving surgery, physical therapy, injections, prescriptions, diagnostic testing, or specialist treatment may require medical evidence establishing that the treatment is connected to the work injury and medically necessary.
How Long Do I Have to Fight a Workers’ Comp Denial in Michigan?
Do not wait.
Michigan law generally states that an injured employee should notify the employer of the injury within 90 days. A worker generally has up to two years from the injury or the date the disability becomes apparent to bring a workers’ compensation claim, although exceptions and additional rules may affect the deadline. Michigan also limits how far back certain past-due benefits may be recovered.
These time limits can become complicated in cases involving:
- Repetitive-stress injuries
- Occupational diseases
- Gradually developing conditions
- Delayed symptoms
- A pre-existing condition aggravated by work
- An employer that failed to report the injury
- Benefits that were paid and later stopped
- Multiple employers
- A worker who did not immediately realize the condition was job-related
Waiting can also make it harder to locate witnesses, obtain surveillance footage, preserve workplace records, and secure strong medical evidence.
What Happens at a Michigan Workers’ Comp Hearing?
At a workers’ compensation hearing, both sides may present evidence concerning whether the worker is entitled to benefits.
The disputed issues may include:
- Whether the injury arose out of employment
- Whether the injury occurred in the course of employment
- Whether work caused or significantly aggravated the condition
- Whether the worker is disabled
- Whether the worker suffered wage loss
- Whether medical treatment is reasonable and necessary
- The correct average weekly wage
- Whether the worker can perform suitable employment
- Whether benefits were improperly stopped
- Whether the worker gave proper notice and made a timely claim
A workers’ compensation magistrate—not an insurance adjuster—can issue a decision regarding the disputed benefits.
Can I Appeal the Magistrate’s Decision?
Yes. A final order issued by the Michigan Workers’ Compensation Board of Magistrates may generally be appealed to the Workers’ Disability Compensation Appeals Commission within 30 days of the mailing date of the order.
Additional deadlines apply to transcripts, briefs, cross-appeals, and further appeals. Missing one of these deadlines can seriously damage the case.
This is different from challenging the insurance company’s initial denial. The WC-104A process begins the formal dispute. An appeal usually occurs after a magistrate has issued a decision.
Do I Need a Lawyer After a Michigan Workers’ Comp Denial?
You are not legally required to hire an attorney, but a denied claim can quickly become complex.
The employer and insurance company may have adjusters, medical reviewers, defense attorneys, and investigators working on the case. You may need to prove medical causation, disability, wage loss, timely notice, and entitlement to treatment.
A Michigan workers’ compensation attorney can:
- Review the exact reason for the denial
- Collect supporting medical evidence
- Communicate with the insurance company
- File the WC-104A application
- Obtain wage and employment records
- Prepare witnesses
- Question doctors through depositions
- Negotiate disputed benefits
- Represent you before the magistrate
- Evaluate a proposed settlement
- File an appeal when necessary
Workers’ compensation is all Steele Law does. From its Flint office, Steele Law represents injured workers throughout Michigan, including workers in Metro Detroit, Lansing, Grand Rapids, Ann Arbor, Saginaw, Bay City, Traverse City, and surrounding communities. Steele Law offers free consultations for injured workers and denied-claim cases.
Frequently Asked Questions About Denied Michigan Workers’ Comp Claims
Is a workers’ comp denial final in Michigan?
No. An insurance company’s denial does not necessarily end your case. You may challenge the denial by filing an Application for Mediation or Hearing and presenting evidence supporting your right to benefits.
What form do I file after a workers’ comp denial?
An injured worker commonly files Form WC-104A, Application for Mediation or Hearing, when an employer, self-insured employer, or insurance carrier disputes the claim.
Who decides a disputed workers’ compensation case?
A Michigan workers’ compensation magistrate can hear the evidence and decide whether benefits are owed.
Can my claim be denied because I had a pre-existing condition?
The insurance company may use a pre-existing condition as a reason to deny the claim. However, a worker may still have a valid case when employment caused, contributed to, or significantly aggravated the condition. The medical evidence is especially important in these cases.
Can workers’ comp stop paying after initially accepting my claim?
Yes. An insurer may later stop wage-loss payments or dispute continuing medical treatment. A termination of benefits can also be challenged through the Michigan workers’ compensation system.
Can I use my own doctor?
During the first 28 days of treatment, the employer generally has the right to select the doctor. After that period, you may change doctors after notifying the employer and insurance carrier, preferably in writing.
What happens if my employer refuses to report my injury?
You may file Form WC-117, Employee’s Report of Claim, directly with the Michigan Workers’ Disability Compensation Agency. The agency will process the form and notify the employer and insurance carrier.
Can I receive benefits while working light duty?
You may qualify for partial wage-loss benefits when you return to medically appropriate work but earn less because of your work-related restrictions. The amount depends on your prior wages, current earnings, and residual wage-earning capacity.
How long does a denied workers’ comp case take?
The timeline depends on the disputed issues, medical evidence, number of witnesses, hearing schedule, negotiations, and whether an appeal is filed. Some cases resolve through negotiation or mediation. Others require depositions and a full hearing.
How much does it cost to speak with Steele Law?
Steele Law offers free consultations to injured Michigan workers. There is no obligation to call and discuss a denied claim.
Your Claim Was Denied—Your Case Is Not Over
A workers’ compensation denial can leave you without income, medical treatment, or a clear way forward. Do not assume the insurance company has the final word.
Steele Law represents injured workers throughout Michigan in denied workers’ compensation claims, disputed medical treatment, stopped benefits, wage-loss cases, occupational disease claims, and serious workplace injury cases.
Call Steele Law today at 248-704-2542 for a free consultation.
The sooner your claim is reviewed, the sooner evidence can be preserved, deadlines can be evaluated, and action can be taken against an improper denial.
Your employer has an insurance company protecting its interests. You deserve a Michigan workers’ compensation lawyer protecting yours.
