If you have been injured on the job, there are a lot of issues that can arise if your injury is covered by your employer’s Worker’s Comp carrier. One of the more stressful issues is the Worker’s Comp hearing. Hearings can be complicated to navigate if you do not have experience with them. Judges often limit the evidence that injured employees are allowed to offer at a hearing or limit the scope of the issues that will be decided at the hearing. Problems with witnesses testifying as anticipated or unexpected witnesses appearing to testify. If the hearing goes wrong and you are denied your Worker’s Comp benefits, your only option may be to appeal. If you find yourself in this situation, let our Joplin Workers Compensation attorney help.
The Workers’ Compensation Appeals Process
The Worker’s Compensation system is based on administrative law which means that an administrative agency oversees the entire system under the authority of the governor. Administrative law judges conduct hearings that are similar to civil trials. When you receive an unfavorable decision after your worker’s compensation hearing, you can first appeal to the Worker’s Compensation Court of Appeals. This “court” is also an administrative law panel. If you are unhappy with the result you get there, the next step would be to seek judicial appellate review in either the state supreme court or court of appeals.
What are the Most Common Reasons Workers Comp Claims are Denied?
One of the most common reasons that workers’ compensation claims are denied is that the claim was not filed or reported to the employer within the required time limits. The law requires that a worker report the claim immediately, sometimes within a matter of days. In turn, the employer is required to notify its workers’ compensation insurance carrier just as quickly. If those deadlines are not met, the claim will likely be denied.
Another common reason is that the employer disputes the claim, usually asserting that the accident did not occur at work, or that your injury or illness was preexisting. Some state worker’s compensation laws do not cover certain conditions, for example, those that are stress-related. Your claim denial letter should state the reason(s) your claim was denied.
What are the Necessary Steps to Appeal a Decision?
The steps in the Worker’s Compensation Appeals process vary from one state to the next, but in there are some general stages in the process that everyone must complete in order to appeal their decision. If your claim for benefits is denied, the first step is to determine why. Again, the reason(s) should be indicated in the denial letter. It may be an issue that can quickly be resolved, such as failure to submit a particular document or piece of evidence. Once you determine the reason, you can request that the insurer reconsider its decision, especially once you have provided any missing documentation.
If these steps do not resolve the issue, you can file a formal appeal within the guidelines established by your state administrative agency. A Joplin workers compensation attorney can be very helpful in making sure all of the requirements are met.
What Does the Appellate Panel Look for in Reviewing a Decision?
At the appeal hearing, you will be required to present medical and other factual evidence to support your workers’ compensation claim, whether it is a work-related injury or occupational disease. Usually, the review of a worker’s compensation decision is limited to only questions of law. This means, the facts will be assumed to be what the hearing judge determined them to be and only the law will be considered to determine if there were any errors. This would include the character or veracity of any witnesses and other evidentiary rulings.
Should I Hire a Joplin Workers Compensation Attorney to Handle my Appeal?
If you hire a Worker’s Compensation Attorney to assist you, he or she can determine why your worker’s compensation claim was denied and begin to obtain the necessary documentation and evidence to prepare for an appeal. Your attorney can also contact necessary witnesses and retain experts if necessary, to support your case. As many worker’s compensation claims are denied because of medical issues, your attorney can have you evaluated by an independent medical expert, if it will help your case. Under the law, a Joplin workers compensation attorney is paid based on a small percentage of the benefits you receive for your claim, so attorney fees should not be an issue for you.
Appealing an unfavorable decision from a workers’ compensation claim or hearing can be very tough. You must convince the reviewing court that good reasons exist to change the administrative judge’s decision. You will be required to follow the specific rules that set out the time limits, as well as the filing and evidentiary requirements during the appeals process. Choosing a Joplin workers compensation attorney who understands the appeals process will ensure that you are able to meet the challenge.
If you have questions regarding appeals or any other workers compensation matters in Arkansas or Missouri, please contact the Cottrell Law Office for a free consultation. You can contact us either online or by calling us toll-free at (888) 616-6356.
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