The process of appealing a workers’ compensation denial can be a confusing process. One of the reasons for this confusion can be the fact that many levels of appeal or reconsideration exist following the receipt of a denial.
How many times can an injured employee appeal a workers’ compensation denial? We have asked lawyer, Alaina Sullivan, and here is what she had to say:
What Is Workers’ Compensation?
Workers’ compensation is a form of insurance employers are required to purchase to cover damages for injured employees who are hurt while at work. This insurance provides benefits for medical expenses, both past and future, lost wages, and temporary or permanent disability payments.
If the injured employee must appeal the case and hire a lawyer, legal fees can also be included as part of a workers’ compensation settlement. However, if the employee chooses to file for workers’ compensation, he or she waives the right to pursue a legal claim against the employer through a personal injury lawsuit.
Receiving a Denial – Now What?
No one wants to be denied their benefits for injuries sustained at work, but most initial workers’ compensation claims are denied for one reason or another. However, it is important that the employee not be discouraged and give up if his or her claim is denied.
The letter that accompanies the denial will explain the reasons why the claim was denied. Many times, it can be something as simple as a mistake in the paperwork. Other times, it can be a much more substantive dispute over the injury or the requests made of the employee.
It is at this point, that an appeal can be made, and the instructions for the appeal will be in the letter.
Each state has its own set of laws governing workers’ compensation cases, so it is encouraged that the injured employee consults a workers’ compensation lawyer in his or her state who is knowledgeable in the state’s laws before proceeding.
If the employee works for a federal entity, federal law will govern how the workers’ compensation case will go.
How to Appeal
The letter will detail what the first step will be for an appeal. Usually, the first level is a hearing before an administrative law judge. The employee and his counsel will be able to present medical evidence and all other evidence to support the claim.
This hearing can be through a state labor department or a state workers’ compensation board. It is extremely important that the injured employee note the deadline listed on the letter to ensure that the appeal is made before this time.
The judge will listen to all testimony and review evidence before making a decision regarding benefits. If the judge agrees that the injured employee is entitled to benefits, this will be determined at that time.
If the judge denies the employee’s eligibility to receive workers’ compensation, another appeal is made.
Appealing the Administrative Judge Decision
Normally, an appeal of a workers’ compensation determination must be made within 30 days of the filing of the administrative law judge’s decision. This next appeal is often done on an appellate level still within the administrative law realm, meaning a workers’ compensation board.
If the appeal is allowed, a hearing will be set before a panel of three board members who will review the case. No new evidence will heard at this point, but rather the panel will review the previous evidence and either affirm, modify or rescind the previous decision.
The panel can also order the administrative law judge for further development on the record and testimony. In some states, if the initial panel decision is not unanimous, the injured employee can request a full board review.
Appealing the Board Decision
At this point, if the board denies the claim, the injured can appeal further, but this next appellate level goes to the legal arena. In most situations, this appeal is not to the trial court level but to an appellate division, including even the highest state court.
If a lawyer has not be retained, at this point, it is recommended that one be consulted given the specific legal requirements which will need to be met to be successful in even applying for this appeal.
At this point, if an unfavorable decision is issued, the employee will have exhausted his or her options. It can take months or even years to get on the court’s docket and to get a final decision.
The court can order the case back to the administrative level, issuing instructions to the judge as the court sees fit. At this point, the process can begin all over again.
Contact a Lawyer Today
If you are in the process of pursuing workers’ compensation and have questions what to expect in the appeals process, a workers’ compensation lawyer can help review your case and discuss your options.
A lawyer can listen to the facts of the case and can best advise you on how to proceed. Contact a lawyer experienced in workers’ compensation law to schedule a consultation today.