Appeals Process

What is the Workers’ Compensation Appeals Process?

A denied workers’ compensation claim is frustrating, but it is also not uncommon nor the end of a claim’s chances of being successful. Through the workers’ compensation appeals process, you can still have a chance to get the benefits you need after a workplace accident.

The workers’ compensation appeals process begins with the Workers’ Compensation Appeals Board (WCAB) or Workers’ Compensation Commission (WCC), depending on your state. You will likely be required to arrange a workers’ compensation hearing with the relevant agency, where you will argue your case to an administrative judge. The hearing will take about an hour in most cases, and there will be time for the insurer or other interested parties to give their input as well. If the judge sides with you, then they can undo the denial, or they might side against you, which continues the process.

When the administrative judge sides against you, time is a critical factor. You could have as few as a few weeks to file the appeal before the case closes, so it is important to act quickly.

In California, you only have:

• 20 days if the judge’s previous denial was immediately relayed to you.
• 25 days if the decision was sent to you via the postal service.

To file an effective appeal against the judge’s decision, there must be reasons to believe that the decision was not based on the evidence available in the case. In other words, there must be a factual or clerical error to back your appeal, not just a disagreement with the outcome.

When the WCAB or WCC reviews your appeal, it can:

• Agree with the previous decision
• Overturn the previous decision
• Instruct the first judge to re-review the case

If your workers’ compensation claim is still denied after this initial appeal, then you can file for an appeal to a California circuit court, which will involve an entirely new set of laws and litigation expectations. If you don’t have a workers’ compensation lawyer already, then it is highly advised you hire one at this point.

How Long Does a Workers’ Comp Appeal Take?

Your workers’ compensation appeal could take a few months if it is successful because the WCAC/WCC will need to make time to hear your case. If there are delays or the previous decision is affirmed, then it could take another few months more still. It is difficult to predict how long a workers’ comp appeal – or any legal appeal, for that matter – will take because each case is so unique. However, you should expect to be in the process of appealing for at least 60 days.

What Questions Are Asked at a Workers’ Comp Hearing?

The workers’ compensation hearing can be intensive, as all parties involved, including the administrative judge, are going to have plenty of questions. If you have not prepared ahead of time with a workers’ compensation attorney, then you could be left in a precarious situation of rushing to answer questions and possibly jeopardizing your case. We recommend that you hire a workers’ compensation lawyer before your initial hearing for at least this reason.

Questions you could be asked at the workers’ comp hearing will inquire about:

• Why your workplace accident happened
• If there are medical records to back up your statements
• If you have been following your doctor’s treatment plan
• Whether or not your injury could be preexisting

You might also be asked if parts of your story have been fabricated or exaggerated. Typically, judges do not ask this question unless the opposing parties have brought forth evidence that could suggest you would lie to try to get your claim approved.