A denied DBA claim is not the end of the road. The appeals framework under the Defense Base Act and the Longshore and Harbor Workers' Compensation Act — which the DBA incorporates — provides multiple avenues for challenge. Choosing the right one requires an assessment of the denial basis, the strength of the available evidence, and the client's circumstances.
Understanding Why Claims Are Denied
Before selecting an appeal strategy, the denial must be thoroughly analysed. Common denial grounds include disputes over the existence or extent of disability, challenges to the work-relatedness of the condition, disputes over average weekly wage calculations, and procedural issues such as late filing. The appropriate response differs significantly depending on which of these applies.
The Informal Conference
In many cases, the first step following denial is an informal conference with the OWCP district office. This provides an opportunity to present additional evidence, address factual disputes, and potentially resolve the matter without formal litigation. While not always productive, informal conferences are a low-cost way to test the carrier's position and identify the key issues in dispute.
Formal Hearing Before an ALJ
If informal resolution fails, a formal hearing before an Administrative Law Judge provides a full evidentiary proceeding. Both sides present medical evidence, witness testimony, and legal argument. The ALJ's decision can be appealed further to the Benefits Review Board and subsequently to the federal courts of appeal.
The Supplemental Claim Route
For claims denied on medical nexus grounds, a supplemental claim supported by new and relevant evidence — typically a stronger nexus opinion or newly identified presumptive coverage — is often the most efficient route to resolution. The PACT Act has created significant new supplemental claim opportunities that should be assessed in every historically denied case.