Claim denials, requests for review, and requests for reconsideration
Workers' comp denied? We examine the grounds for denial and handle your request for review or reconsideration.
We handle disputes over work-relatedness, and we also represent clients appealing decisions on disability grade, the payment period for temporary disability (lost-wage) benefits, and average wage. Just bring the notice you received from KCOMWEL to your consultation.
What are a request for review and a request for reconsideration?
These are procedures for asking that a decision be reconsidered when you disagree with KCOMWEL's benefit decision or a similar ruling. A request for review is filed with KCOMWEL. A request for reconsideration is filed with the Industrial Accident Compensation Insurance Reconsideration Committee. If a benefit decision went through the Occupational Disease Adjudication Committee, you can skip the request for review and go straight to a request for reconsideration. An administrative lawsuit is a separate process for challenging KCOMWEL's decision in court.
Deadlines for review and reconsideration
When did you learn of the decision? Review and reconsideration have filing deadlines.
The date a decision is issued and the date you learn of it aren't the same. Check the date you received the mailed or electronic notice, and confirm the 90-day filing deadline first. If you miss it, your request will be dismissed.
Request for review: within 90 days
Counted from the date you learned of the benefit decision or similar ruling.
Request for reconsideration after a review decision: within 90 days
Counted from the date you learned of the decision on your request for review.
Request for reconsideration without a review: within 90 days
Counted from the date you learned of the benefit decision that went through the Occupational Disease Adjudication Committee.
Responses by ground for decision
We identify KCOMWEL's grounds for denial and build an argument against each one.
Missing work periods or workload
We use employment insurance history, pay records, daily work logs, schedules, and coworker statements to prove the work periods, workload, and job demands that KCOMWEL's investigation missed.
Work-relatedness rejected
We compare your job duties with your diagnosis and test results, and we challenge findings based on a preexisting condition, natural progression, or a non-work accident.
Recognition criteria misapplied
We compare the laws and official notices with the actual facts, and point out factors that were left out or standards that were applied incorrectly.
Disputes over grade, payment period, or average wage
We review disability diagnoses and tests, medical care and employment history, and wage records and calculation sheets. You can challenge a benefit decision itself, separate from whether your claim was approved.
Choosing a procedure and scope of work
You can also file an administrative lawsuit without going through review or reconsideration.
The right procedure depends on the type of decision and where your case stands now. If you disagree with a review decision, we confirm the next step, such as a request for reconsideration, and its deadline. If the benefit decision went through the Occupational Disease Adjudication Committee, you can skip the request for review and go straight to a request for reconsideration. You can also file a lawsuit to cancel the decision without going through review or reconsideration. The deadline to file is within 90 days of the original decision, the review decision, or the reconsideration decision, as applicable. Representation in an administrative lawsuit is separate from our engagement for review and reconsideration. Hiring an attorney requires your consent and a separate agreement.
Sobaek's practice areas
We pinpoint where KCOMWEL got it wrong and write the statement of grounds for review or reconsideration.
- STEP 01
Confirm the reasons for the decision and the time left
We review the decision notice, the actual notice date, and the records already submitted. We obtain the records we need, such as the accident investigation report and the reasons for the ruling.
- STEP 02
Write and file the statement of grounds
The statement lays out where KCOMWEL's decision went wrong, the facts and supporting evidence we'll use to rebut it, and the standards that apply. We also check whether an additional medical certificate is needed.
- STEP 03
Handle the review or reconsideration
We submit additional records and written opinions, and explain the grounds for the request at the hearing. If you still disagree after the decision, we explain the next appeal step and its costs.
Frequently asked questions
Find answers to your questions before a consultation.
Another office filed my claim and it was denied. Can I hire Sobaek now?
Yes, you can hire us starting at the appeal stage. We'll need to review your original application, the records submitted, and KCOMWEL's decision, so let us know what records you have and the date you received the notice.
Can I still appeal without a new medical certificate or new evidence?
New records aren't always required. Misread evidence, missing facts, or errors in applying the law or standards can also be grounds for appeal. The first step is deciding whether there's a real basis to challenge the decision.
My claim was denied by the Occupational Disease Adjudication Committee. Do I have to start with a request for review?
If the benefit decision went through the Committee, you can go straight to a request for reconsideration. We need to check the decision type and whether the Committee reviewed it, then calculate the deadline that applies.
My workers' comp claim was approved. Can I challenge just my disability grade or temporary disability (lost-wage) benefits?
Yes. Benefit decisions such as disability grade, the payment period for temporary disability (lost-wage) benefits, and average wage can also be appealed. We'll need to check the decision notice and the notice date.
The company says it will provide more records. Is it OK to wait?
Don't let the appeal deadline pass while you wait for records. Start by confirming the filing deadline using the decision notice and records you have now, then decide how to submit additional records.
What if it's already been more than 90 days?
Even if 90 days have passed, you can file a new claim with KCOMWEL, get a new decision, and move forward from there.
If my request for reconsideration is also denied, do I have to sue?
Whether to sue depends on the grounds left to argue, the additional proof needed, and the cost. If you choose to sue, don't miss the filing deadline, and confirm the scope of the attorney's engagement and the fees separately.
What's the deadline for filing an administrative lawsuit?
If you go straight to court, as a general rule you need to check both limits: 90 days from the date you learned of the decision and 1 year from the date the decision was made.
Request a consultation on a workers' comp or labor case
Talk to us about a workers' comp denial.
Share KCOMWEL's decision and the date you received the notice. We'll base the consultation on the records already submitted and the grounds for denial.
You can also email us directly
For corporate advisory work, new cases, or meeting requests,
email us at the address below.