If your workers’ compensation claim was recently denied, you may be contemplating whether or not to appeal. Or, maybe, your workers’ comp lawyer has already told you that you’ve got a good chance of winning an appeal following a judge’s ruling against you. Whatever the case may be, you will need to know what to expect before entering into the complicated process that is characteristic of workers’ comp appeals.
If you’re considering an appeal and want to proceed without a lawyer, you should know that very few workers’ compensation claims are ever overturned on appeal when the injured worker represents himself.
A Long and Winding Road
The Workers’ Compensation appeals process is a difficult and time-consuming one. One of the most frustrating aspects of these claims is that you’re only involved in one because you’ve been seriously hurt on the job and probably can’t work. While you’re unable to work, your stress is compounded by the fact that you’re in the middle of a waiting game, and your lawyer’s pace is limited by the slow-moving workers’ comp system.
A contested workers’ compensation case begins when you and your lawyer formally dispute the decision of the workers’ compensation provider regarding your workers’ comp claim. Once your case has been filed with the state workers’ compensation commission, a hearing will be scheduled to discuss the facts of your claim.
After you receive what’s called a “denial notice,” you (and your lawyer) will contact the employer’s workers’ compensation insurance company and ask for more information about why your claim was rejected. The letter you receive in the mail will only have a very brief explanation; your lawyer will be able to get details that many people would not be able to get without legal representation.
If a claim was denied due to missing information or incorrect paperwork, you may be able to fix these errors or omissions and have your claim reconsidered. If your claim was denied for other reasons like lack of evidence, lack of credibility on the injured worker’s part, or some other reason more serious than missing information or incorrect paperwork, you and your lawyer will have to discuss why you were denied and decide whether or not to appeal. More paperwork will be required to officially file an appeal—paperwork you will need a lawyer to fill out correctly.
Workers’ Compensation Mediation
Many states offer the opportunity for mediation before your appeals hearing, and some states even require mediation prior to a hearing. In mediation, both sides get the opportunity to present their case to a neutral third party, a mediator, to help settle the dispute. Mediation typically involves the parties meeting and discussing informally in a conference room—not a courtroom.
It’s helpful and highly recommended to have an attorney present during mediation. Any agreements reached during mediation will be formalized in writing and reviewed by a workers’ compensation judge. If you cannot agree to a settlement through mediation, you will then proceed to the next step, whatever that is according to workers’ compensation law in your state.
You may proceed to a formal workers’ compensation hearing, which is similar to a trial but much less formal. Both sides will make arguments and present evidence, including testimony from witnesses and medical experts. A judge will preside and procedural rules will be followed. You must convince the judge that the initial decision to deny your claim was wrong. The evidence presented at this hearing depends on your claim and why you were denied in the first place.
If you lose at the hearing, you may appeal that ruling. When this happens, a select panel of workers’ compensation judges will handle the appeal. This is not an opportunity to present new evidence; it’s simply your time to show why the initial decision against you was wrong. If you lose an administrative appeal, the final step is to appeal the denial of benefits through the state court system. At this time, your case will proceed through the courts like any other trial, and a judge or jury will make the final decision, and at this time, all appeals will have been exhausted.