As if being injured on the job was not stressful enough, a worker’s compensation hearing can be even more frustrating. Perhaps the judge limited the evidence you could present or the subject matter you could address. The witness may not have been entirely truthful and now you have lost your case. When this happens, and your worker’s compensation benefits have stopped, your only recourse is an appeal. What should you expect? Let our Worker’s Compensation Attorney help.
The laws which govern the worker’s compensation appeals process can be very complicated, with the strict requirements and deadlines. It is crucial that you discuss your case with an experienced workers’ compensation attorney and obtain his or her assistance during your appeal.
The Workers’ Compensation Appeals Process
The Worker’s Compensation insurance system is grounded in administrative law, meaning 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 that result, the next step would be to seek judicial appellate review in either the state supreme court or court of appeals.
Common Reasons for Denial
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 the state 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.
Steps to Appeal the 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. The letter you received stating your workers’ compensation claim was denied may also describe how you can appeal the denial of your claim. Make sure you read the letter carefully, and note any appeal deadlines. An Worker’s Compensation Attorney can be very helpful in making sure all of the requirements are met.
What does the appellate panel look for?
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 an 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 Worker’s 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 Worker’s 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 Worker’s Compensation issues in Arkansas or Missouri, please contact the Cottrell Law Office for a consultation, either online or by calling us as (888) 433-4861.
He is licensed to practice law in the United States District Court for the District of Kansas, eastern Arkansas, western Arkansas, and western Missouri. He was Deputy Prosecuting Attorney in Crawford County, Kansas from 1987-1989.
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