What Happens if My USL&H Claim Is Denied?

Our firm often hears the question, “What happens if my USL&H claim is denied?” Under the United States Longshore and Harbor Workers’ Compensation Act, you have the right as a dockworker, ship loader/unloader, or other harbor employee to seek benefits if you are injured. 

Doing so can be difficult with complicated rules and paperwork, and your claim could be denied if you make a mistake, but you have the right to appeal.

The best course of action is to work with an experienced New Orleans Longshore and Harbor Workers’ Compensation Act lawyer who will review your claim and help you file your appeal. Through careful preparation, you can submit additional documentation and correct errors to show you deserve full benefits. 

Read more to learn how to take action and get results. 

Who Is Eligible Under the LHWCA

Maritime law is highly complex and dependent on the type of work you do and where you perform those tasks. For example, if you are part of a domestic fishing fleet, you can turn to the Jones Act. However, those who are loaders, shipbuilders, ship breakers, and other dockworkers have remedies under maritime law.

These individuals turn to the US Longshore and Harbor Workers’ Compensation Act. By filing a USL&H claim, you can qualify for partially paid wages, disability benefits, medical payments, and other support. The requirements are that you do work related to maritime commerce and that your work takes place on or near the water. 

If your work is clerical, administrative, or only part-time near the water, you may not qualify for a USL&H claim. For example, if you work for a vendor that supplies a dock area but do not spend most of your time there, you would seek compensation through your own employer’s workers’ compensation insurance. 

Reasons Why Your USL&H Claim Might Be Denied

Dock and longshore work is extremely dangerous. Working with heavy equipment, hazardous substances, and oversized cargo means it’s easy to get hurt even when you follow the fuels and take all the safety precautions.

Unfortunately, insurance companies are always looking for fraud, so you could face a denied USL&H claim even if you did everything right. 

Here are common reasons why your claim could be denied and require an appeal:

• You didn’t provide evidence you were hurt on the job.
• You made mistakes on the form, such as the date you were injured.
• You didn’t report the injury to your employer within 30 days.
• You don’t qualify under the LHWCA and should request benefits another way.
• You intentionally hurt yourself or engaged in prohibited behavior, such as fighting.
• You were intoxicated on the job when you were hurt.
• You neglected to follow safety guidelines or other protocols.

Some of these issues can be fixed by submitting new or corrected materials to the claims examiner. Others, such as potential negligence or claiming you were hurt on the job, may require skilled intervention from an experienced maritime lawyer who can protect your rights and prepare your case.

They can use their knowledge of the law, their background working with insurance companies, and their network of medical and other professionals to build a robust appeal for you.

How to Appeal Your LHWCA Claim

When you file your Longshore and Harbor Workers’ Compensation Act (LHWCA) claim, you must supply records and other documents to show how you got hurt on the job and how severe your injuries are.

When you were hurt, you should have notified your employer as soon as possible and gotten appropriate medical care. Using those records and any additional proof of injury, you can submit your claim.

The claims staff in the Office of Workers’ Compensation Programs will review your materials and may issue a denial of your USL&H claim. If they do, you can work with a skilled maritime injury lawyer to adjust your claim by collecting more documentation and correcting any mistakes.

Your attorney can request an informal meeting to discuss the denial and possibly fix the problem quickly.

If this doesn’t work, your lawyer can submit a formal claim that allows you to present your side in front of an Administrative Law Judge (ALJ). If the ALJ still denies the claim, you can proceed to the Benefits Review Board, ultimately going on to a U.S. Court of Appeals, if needed.

Preparing to Appeal Your USL&H Claim Denial

The most important thing to remember is that a claim denial is just a temporary delay, not the end of the world. While you need your benefits to recover and get back to work, it may take a little more time.

Choosing a top-notch maritime attorney when your USL&H claim is denied gives you the powerful legal support you need to clear things up.

Here’s what we recommend for the best chance of success:

• Allow your lawyer to carefully review your denial letter so they can determine the exact issues.
• Work with your attorney to gather and organize the necessary materials to address the reasons for the denial.
• Request an informal conference with a claims examiner to provide your new documentation and potentially clarify the issues.
• If needed, file a formal appeal claim so you can present your documentation to an ALJ.

While you can do most of this on your own, it’s wise to remember that you’ll also be dealing with your injuries, including pain and medical appointments.

Finding the time and energy to untangle the complex appeal process may be too much for you. In addition, if you need to continue appealing to a federal appeals court, you must have an attorney do this work for you. 

Learn More About What Happens When Your USL&H Claim Is Denied

At Scott Vicknair Injury Lawyers, our team is dedicated to helping you overcome any challenges and help you understand what happens when your USL&H claim is denied. We stand ready to answer your questions and provide guidance during a free consultation. 

Connect with us online or by phone to arrange your case review with a compassionate and accomplished New Orleans Longshore & Harbor Workers’ Act lawyer today.