Who typically handles the appeal process if a denial is contested?

The appeal process for a contested denial is typically handled by an Administrative Law Judge (ALJ). An ALJ plays a crucial role in managing disputes related to workers' compensation cases, including those involving denied claims. Their function is to conduct hearings, assess evidence, and make impartial rulings based on the facts presented and applicable laws. The ALJ’s expertise in legal standards and procedures helps ensure that the appeal process is fair and just for all parties involved.

In contrast, other individuals or representatives, while they may play significant roles in the claims process, typically do not have the authority to adjudicate disputes. A work supervisor generally oversees operational aspects within a workplace but does not engage in the legal proceedings of claims appeals. The injured worker's representative may advocate for the worker but usually does not handle the formal appeal process itself. The insurance company’s attorney may represent the insurer during the appeal but does not serve as the neutral party that the ALJ represents. Thus, the Administrative Law Judge is specifically designated to oversee and resolve contested claim appeals, ensuring that decisions are made according to the law.