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How to Appeal a Workers’ Compensation Decision

How to Appeal a Workers’ Compensation Decision

You can appeal a workers’ compensation decision by filing a Petition for Reconsideration with the Workers’ Compensation Appeals Board (WCAB). This organization processes appeals from injured and sick workers seeking fair compensation for their losses.

While you always hope that the insurance company will pay the compensation you deserve right away, this isn’t always the case. A claim denial or low settlement offer is not the end of your claim. You can appeal for the benefits you deserve, and a workers’ comp lawyer can help.

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Why You May Need to File an Appeal of a Workers’ Comp Decision

Image showing paperwork related to worker injury and disability compensation, including Social Security claim documents.

You may need to file a Petition of Reconsideration with the WCAB if:

There may be other reasons to initiate an appeal. Some issues can be solved by negotiating with the insurance company. Other problems, including a claim denial, may need to be resolved through appeals.

How to File an Appeal with the WCAB

If you need to file an appeal, you will:

  • File the Petition for Reconsideration
  • Receive notice from the WCAB that your petition has been received
  • Receive your case number
  • File a Declaration of Readiness to Proceed, which will inform the WCAB that you are ready to move forth with the appeal
  • Receive notice of a Mandatory Settlement Conference (MSC), which is a form of hearing

Your attorney will oversee these steps for you. They will ensure your appeal is filed promptly and that the WCAB is taking appropriate action with respect to your petition.

What Happens After the WCAB Schedules My Hearing?

Once you have received a date for your MSC, you will next:

  • Appear at your hearing (alongside your lawyer if you choose to hire one)
  • Listen to a judge explain the details of your case
  • Receive assistance from the judge in attempting to reach an acceptable settlement with the insurance company

If you and the insurance company do not reach an agreement at the MSC, a trial may come next. It will mean that you (or your lawyer) will:

  • Present documentation detailing the exact nature of the dispute
  • Provide a list of items you plan to present during the trial, including the names of any witnesses who will testify on behalf of your case
  • Receive a date and location of your trial

Another judge will oversee the trial, and your attendance is mandatory if you wish to resolve the case in your favor. Your attorney will lead every trial step, including questioning witnesses and presenting evidence.

You will receive a decision from the judge presiding over your trial between 30 and 90 days of the trial’s completion.

There Are Deadlines for Filing Workers’ Comp Appeals

Workers’ compensation rules state that there are typically deadlines for filing a Petition for Reconsideration with the WCAB. It is critical that you comply with these deadlines, as your petition will likely be dismissed if you do not.

Should I Hire a Workers’ Compensation Lawyer to Help Me Appeal a Denial?

Countless injured and sick workers fail to secure the compensation they deserve for their losses. If you can speak with these parties, they might tell you they wish they’d hired an attorney to lead their claims.

There are many strong reasons to hire a workers’ comp lawyer, whether you are pursuing an initial claim, appeal, or lawsuit. These reasons include:

  • The time, energy, and knowledge required to complete a claim successfully: Do not underestimate the demands of a workers’ compensation claim. The person handling the case may need to invest many hours of work, countless brain cells, and plenty of energy to complete the claim successfully. If you suffer an injury or are sick, you may not have what it takes to meet these demands.
  • The need for you to prioritize recovery: Your sole focus should be on healing. You may also have personal obligations that require your attention. By allowing an attorney to handle your claim, you can keep your focus where it is most needed.
  • The experience an attorney offers: Your lawyer will have priceless experience completing workers’ comp claims and personal injury lawsuits. This experience may provide benefits in several aspects of your case.
  • The financial resources law firms provide: Law firms provide many resources you may not have direct access to. It includes, but is not limited to, hiring experts who can strengthen your claim.
  • The high financial stakes of your claim: You may deserve tens or hundreds of thousands of dollars in benefits or financial awards if not more. In cases of disabling injuries, the cost of a case is particularly high. You should do everything you can to secure the compensation you deserve, and that may include hiring a lawyer.

If you are eligible to sue anyone for a work-related injury or illness, having a lawyer will allow you to file and complete your lawsuit as soon as possible. Most injured workers are unfamiliar with the legal process, so hiring a lawyer may be a no-brainer.

There Are Risks in Dealing Directly with Insurance Companies

A lawyer will protect you from having to interact directly with insurance companies. You may risk making a costly mistake whenever you speak with or submit information to an insurance company.

Having an attorney will ensure:

  • You do not say anything to insurance representatives that may compromise your claim
  • You respond appropriately to a denial of your claim
  • You will not be swayed to accept a lowball settlement offer
  • Your claim does not suffer from unnecessary delays
  • There are no other preventable problems related to your workers’ comp claim

Every injured worker deserves this protection and can receive it by hiring a workers’ comp attorney.

How a Lawyer Can Assist with Your Workers’ Comp Claim and Appeal

Employee with injury seeks legal advice from lawyer regarding insurance coverage

Expect comprehensive assistance from your workers’ compensation lawyer. Though the needs of every injured worker are unique, your lawyer will:

Investigate How You Suffered a Work-Related Injury or Illness

Your lawyer will document the event or circumstances that have caused your health problems. They may gather evidence to use in your claim or lawsuit, including:

  • Witness accounts
  • Video of the harmful event
  • An expert’s reconstruction of the accident
  • An incident report created by your employer

This evidence may be necessary if the insurance company or other liable parties dispute your account of events.

Make Clear That Your Own Negligent Actions Did Not Cause the Injury

One way for an insurance company to fight your claim is to accuse you of:

  • Causing your injury intentionally
  • Suffering an injury while engaged in horseplay
  • Being under the influence of alcohol or drugs when the injury happened
  • Suffering the injury outside the scope of employment-related duties

The evidence your workers’ comp attorney collects should make clear that you suffered an injury or illness in the normal course of your work.

Detail the Harm You’ve Suffered

Insurance companies and other liable parties will likely need proof of your losses. Such proof can include:

  • Experts’ opinions about your losses, which may include testimony from doctors and mental health professionals
  • X-rays and other medical images
  • Medical bills
  • Evidence of lost income, lost earning power, and other professional damages
  • Any other documentation that helps prove your losses

Your lawyer will work with the necessary authorities (like your doctors) to obtain all relevant documentation.

Calculate the Value of Your Claim

Your legal team will assign a specific dollar figure to your losses or damages. This figure will reflect both current and future harm you suffer because of your work-related injury or illness.

Negotiate with the Insurance Company

Your lawyer will meet with your lawyer’s workers’ compensation policy provider. Their goal will be to obtain a financial settlement covering all your losses.

The negotiation process may require your lawyer to:

  • Cite specific details of your employer’s workers’ compensation policy
  • Present documentation of your losses
  • Detail their calculation of your losses
  • Address counterarguments from the insurance company
  • Counter lowball settlement offers

Your lawyer will be comfortable during settlement negotiations, while you might not be so comfortable if you were negotiating on your own.

Lead Any Lawsuit You Are Eligible to File

If you sue, it is statistically likely that your case will settle. However, your lawyer only advises you to settle if the offer is fair.

If your lawyer negotiates a settlement with liable parties but never receives a fair offer, they may advise you to go to trial. If you do so, your attorney will lead every step in the trial process, including questioning witnesses, presenting evidence, and urging the jury to pay you fairly.

Protect and Advise You Throughout Your Case

Your attorney knows the uncertainty that comes from a work-related injury or illness. They will make the claims process or your lawsuit as pain-free and thought-free as possible by:

  • Explaining (in clear terms) what to do with respect to your claim or lawsuit
  • Explaining what not to do
  • Updating you frequently as your case moves forward
  • Being available to answer your questions and address any concerns

Your lawyer will also lead any appeal you need to file. They will deal with the Workers’ Compensation Appeals Board and accompany you to all appeal-related appearances.

Can I File a Lawsuit for a Work-Related Injury or Illness?

Employee with injury consulting lawyer for insurance guidance after workplace injury

You might sue one or more parties responsible for an injury or illness. Injured or sick workers can generally file a lawsuit if:

  • A third party, such as the manufacturer of safety equipment, causes you to suffer injury or illness
  • Your employer lacks workers’ compensation coverage
  • Other circumstances make you eligible to sue

Lawsuits can be just as complicated as workers’ compensation claims, if not more so. If you choose to file a lawsuit, allow an attorney to navigate the legal process for you.

If your case goes to trial, your attorney will represent you. Trials can be months- or years-long undertakings that require extensive legal knowledge. With an attorney on your side, you won’t have to face the demands of a lawsuit or trial.

What Losses Can I Seek Compensation For?

The types of losses you receive compensation for may depend on how you seek it. Your lawyer will work to maximize your financial recovery and may be seeking money for the following through different avenues:

  • Medical bills: You should not have to pay for ambulance transport, emergency services, hospital services, medical imaging, rehab, or any other medical services from a work-related injury. Your attorney will document and keep track of your medical bills, ultimately demanding that liable parties cover those bills.
  • Lost income: Your attorney will seek the maximum allowable compensation for your lost income. Workers’ comp generally covers a large percentage of lost income.
  • Other work-related losses: You may be eligible to seek compensation for lost earning power, missed bonus and overtime opportunities, and other professional losses.
  • Disability-related harm: If you need medical equipment, in-home caregiver services, ramps for your home, a new vehicle, or other items or services for a disability, your lawyer will consider such costs.
  • Pain and suffering: You may receive compensation for physical pain, emotional anguish, psychological distress, and other types of pain and suffering.

Having a lawyer explain exactly which losses you deserve compensation for is important. Each case is different, and it is difficult to generalize about your covered losses or recoverable damages.

Can I Afford a Workers’ Comp Lawyer?

Keith More, personal injury lawyer

Workers’ Compensation Attorney, Keith More

You can afford to hire a workers’ comp lawyer because these attorneys usually use contingency fees. This fee structure means the law firm only receives payment for its services if your lawyer obtains compensation for you.

You should wait no longer to hire your personal injury attorney. The claims process is governed by time-sensitive deadlines, as is the legal process. Hire your attorney as soon as possible.

While you can hire an attorney at any point during the claim process, it becomes especially critical once you receive a claim denial or another adverse workers’ comp decision.

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