A workers’ compensation appeal usually takes around two to four months to complete. Note, though, that every workers’ comp case is unique, and an appeal could take slightly less time or slightly more.
Following a workers’ compensation trial, claimants typically initiate the appeals process by filing for reconsideration with their state’s workers’ compensation appeals board. The board can then either grant the appeal, deny it, or dismiss it.
Prior to filing for reconsideration, it is critical for a claimant to contact an experienced workers’ compensation attorney or personal injury attorney for assistance in an appeal.
What is the timeline and process to appeal a workers’ comp denial?
A claimant begins the workers’ compensation appeals process by filing for reconsideration with his/her state’s workers’ comp board. Claimants typically have 20-25 days to file this from the date that they receive the judgement in their workers’ compensation trial.
A claimant should file for reconsideration if either of the following apply:
- the claimant has evidence that contradicts the judge’s decision, or
- the claimant has new evidence that was not presented during his/her original hearing or trial.
Once a person requests reconsideration, the applicable board can take any of the following actions:
- dismiss it,
- deny it, or
- grant it.
The board usually has about 15 days to make this decision after a claimant files for reconsideration. This timeline, though, will vary among different states.
If claimants are not satisfied with a board’s decision on appeal, they can file for review with a state appellate court. This review is often referred to as a “writ of review.”
Note that most jurisdictions say that the appellate court cannot reverse any findings of fact that were made by the appeals board. The court is limited in deciding if the decision reached by the board was reasonable.
What is a workers’ compensation trial?
A workers’ comp trial does not have to take place every time a worker files for benefits.
If an injured worker agrees with the insurance company on all the issues in a claim, there is no need for a judge to make a decision. Instead, there will be a settlement.
A settlement in a workers’ compensation case is an agreement on as to injured workers’ benefits, including:
A settlement is often reached via a:
- Stipulation with Request for Award, or
- Compromise and Release.
If the injured worker cannot reach an agreement with the insurance company on any issue in a claim, a judge will have to make the decision. This is done through a trial.
The judge’s decision at trial on these benefits is final. It cannot be brought up again unless the injured worker files for reconsideration and appeals.
What should a person do after receiving a denial letter or upon deciding to appeal a trial judge’s decision?
If a person was denied workers compensation benefits, or was not happy with the outcome of the workers’ comp trial, then the claimant should:
- contact a workers’ compensation attorney as soon as possible,
- review the denial letter for any errors,
- organize any evidence used in the case and store it in an easy to remember location,
- provide a copy of this evidence to his/her attorney, and
- if unrepresented by a lawyer, file an appeal with the applicable appeals board.
What are some common reasons why a workers’ comp case gets denied?
There are several reasons why a workers’ compensation claim might get denied, or why a judge may make an unfavorable decision at a workers’ comp trial. Some of the most common include:
- there was a lack of evidence or information that supported the claimant’s position or case,
- the claimant missed a filing deadline,
- there were errors in paperwork filed, or
- there was a lack of medical evidence on the claimant’s injuries.
What is the law in California?
Most workers’ compensation appeals in California are referred to as Petitions for Reconsideration.
A Petition for Reconsideration is filed when there is a decision by a judge at trial. An example of this is a decision that denies an injured worker money or treatment.
The Petition for Reconsideration must be:
- filed under oath,[i]
- sent to any other parties involved (for example, any medical providers),[ii]
- filed within 20 days of the judge’s decision, with an extra five days to file if the decision was mailed (meaning a total of 25 days to file),[iii] and
- filed at any Workers’ Compensation Appeals Board District Office.
After the Petition for Reconsideration is filed, the judge that made the original decision has 15 days to change his or her decision.[vi] In that case, the judge may want to take another look at the issue and evidence involved and will set the case for a new hearing.
After a Petition for Reconsideration has been filed, the Workers’ Compensation Board may:
- dismiss it,
- deny it, or
- grant it.
The only other courts that can hear a workers’ compensation appeal are the California Supreme Court or California Court of Appeal.[vii]
Taking a case to the next level above the Petition for Reconsideration filed in the Workers’ Compensation Appeals Board is called a Writ.
A Writ can only be filed after a Petition for Reconsideration.
A Writ must be filed within 45 days.[viii]
Any issue in the Writ must have been in the Petition for Reconsideration.[ix]
[iv] Cal. Lab. Code 5905.
[v] Cal. Code Regs. tit. 8, 10507(a).
[vi] Cal. Code Regs., tit. 8, 10859. See also Cal. Code Regs., tit. 8, 10843(d).
[vii] Cal. Lab. Code 5955.
[viii] Cal. Lab. Code 5950.