Filing a Workers’ Compensation Appeal

Insight from a Workers’ Comp Lawyer

As an injured worker, there are different steps you can take if your workers’ compensation claim was denied. An appeal is one of these steps, typically the last in the process. The first step is to file a case with the Division of Workers’ Compensation (DWC) field office in the county in which you live or were injured. A hearing, called a mandatory settlement conference, will be held to try to reach a settlement between you and the claims administrator who denied your claim. If all matters pertaining to the claim could not be agreed upon at this hearing, your case will go to trial with the Workers’ Compensation Appeals Board (WCAB). A workers’ compensation judge will preside over this trial and render a decision on any and all issues that need to be resolved.

If you are dissatisfied by a workers’ compensation judge’s decision regarding your case, you can appeal this decision. This is accomplished by filing a Petition for Reconsideration with the local district office of the WCAB in your area. You will be notified of the workers’ compensation judge’s decision within 30 to 90 days after your trial, via a notice by mail. Upon receiving this notice, you will have 25 days from the date of the judge’s decision to file an appeal (the date is located near the judge’s signature on the document). If the decision was rendered at the trial, you will have 20 days from that date to file an appeal.

It is important to act quickly if you wish to file an appeal. If you wait too long, you may lose the right to appeal a judge’s decision on your workers’ comp claim, thus affecting your receipt of benefits. At Pacific Attorney Group, we believe in helping our clients seek swift and favorable outcomes to their workers’ compensation claims. Filing appeals is one of the ways we can help our clients seek the benefits to which they are entitled. You can learn more about our firm and your rights as an injured worker by calling a workers’ compensation attorney at our offices.

What are the reasons to file an appeal?

You may be able to file a workers’ compensation appeal if you believe the judge’s decision was reached in error or by fraud, or if new evidence has come to light that could affect his or her decision. The Petition for Reconsideration form lists five primary reasons to appeal a judge’s decision on a workers’ compensation claim:

By the order, decision or award, the Board acted without or in excess of its powers.

The order, decision, or award was procured by fraud.

The evidence does not justify the findings of fact.

Petitioner has discovered new evidence material to him which he could not with reasonable diligence have discovered and produced at the hearing.

The findings of fact do not support the order, decision or award.

In the Petition for Reconsideration, you must completely describe your disagreement with the judge’s decision and why it should be changed. You need to fill out the form completely and honestly and be prepared to provide supporting documentation. The WCAB will then review your petition and will determine how to respond. The Board may support or reverse the judge’s decision or may order your case to be tried again.

Though your claim may have been denied by the claims adjuster and a workers’ compensation judge may have upheld this decision or otherwise ruled unfavorably, you may be able to file an appeal. Contact a workers’ comp lawyer at our firm to find out how you can move forward with your case.

Workers’ Comp Trials

Workers’ Compensation Attorney

When an injured worker disputes a denied workers’ compensation claim and a settlement cannot be reached during a hearing (mandatory settlement conference), the matter may go to trial. It is important to note that workers’ compensation trials are very different than standard civil or criminal courtroom trials that most people are familiar with. In California, a typical workers’ comp trial will take place in a small hearing room at one of the 24 Division of Workers’ Compensation field offices located across the state. There is no jury. A workers’ compensation law judge will preside over the proceedings and make a final ruling based on the evidence at hand.

How a workers’ compensation trial is approached and handled will have a direct impact on its outcome. This makes involving a competent attorney of the utmost importance. If your claim was denied after a work accident, occupational disease or other on-the-job injury, you have the right to challenge this denial. The first step is a mandatory settlement conference, a hearing where a judge will try to help you and your claims adjuster (or his/her attorney) to reach a settlement. If you cannot agree upon a settlement, the matter will go to trial.

Your workers’ compensation lawyer’s preparation and handling of your mandatory settlement conference is just as important as his or her handling of your trial. If one or more issues cannot be resolved during your hearing, these will be resolved during a trial before a different workers’ compensation law judge. At your hearing, however, your attorney will already need to have complete documentation on all evidence and witnesses that will be presented at the trial. No other evidence/witnesses can be submitted after the hearing is over.

What happens at a workers’ compensation trial?

If your case goes to trial, you and your attorney and the claims adjuster and his/her attorney will be present. A workers’ compensation judge will hear the matter; there will be no jury. The trial is overseen by the Workers’ Compensation Appeals Board (WCAB). Depending on the issues you have already resolved during your hearing and which still need to be decided upon by a judge, your trial may only take a matter of minutes or hours. If the trial is not finished on the day it begins, it will not resume the following day. It will be continued to another day, which may be two or three months later. This means that extensive workers’ compensation trials may take years to resolve.

During the trial, the judge will consider the evidence and testimony presented by both sides and will then make a decision on any and all matters that need to be resolved. Each side will have the opportunity to call witnesses and to examine and cross-examine these witnesses. Expert testimony from medical professionals may be given in writing.

The judge will consider all of the evidence and the issues at hand and will render a verdict. In nearly all cases, the judge will not render a verdict on the day of the trial. You will be informed of the decision in the mail anywhere from 30 days to 6 months after the trial. You have the right to appeal a decision made at your workers’ compensation trial, which your attorney can do by filing a Petition for Reconsideration.

Experienced Workers’ Comp Trial Counsel

When faced with a denied workers’ comp claim, do not take any chances by involving an inexperienced attorney. Choose a legal professional who has a track record of success with these complex matters. At Pacific Attorney Group, we represent injured workers throughout the California area in workers’ compensation hearings and trials, using more than 35 years of combined legal experience to seek the best possible result in every case we handle. Find out how a workers’ compensation attorney can help you – call our firm today.