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Medical Provider Claim Denial

Appeal By Medical Provider for Medical Claims Denied By Workers' Compensation

If a claim for medical treatment to treat an injured worker is denied by the industrial insurer or self-insured employer, the medical provider can participate in the informal dispute resolution process through the Labor Commission’s Industrial Accidents Division. If the medical provider is dissatisfied with the Order issued by the Industrial Accidents Division, an Application for Hearing may be filed with the Adjudication Division.

A completed Medical Provider Application for hearing can be filed with the Adjudication Division in person, by mail, by e-mail at or by fax. Once a completed Application has been filed, it will be forwarded to the employer and the designated agent for the employer’s insurance carrier. An Order is also issued requiring a written Answer be filed by the employer/insurer within 30 days. Once an Answer has been filed, a hearing will be scheduled no sooner than 120 days from the date the Answer is filed. The Division conducts its hearings as formal hearings under the Utah Administrative Procedures Act.

File an Application for Hearing

Please fill out the required forms completely. Send them back via fax, regular mail or e-mail to

Application for Hearing Medical Care Provider Claim Denial (For Medical Care Providers Only):