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.
Do You Need a Lawyer for a Workers’ Comp Appeal?
As with most legal situations that go to court, you have the right to represent yourself during a workers’ compensation appeal, from the initial hearings up to appeals to higher courts. However, having the right is not the same as making its use worthwhile. If you want to give yourself confidence that your appeal is formed correctly and has a good chance of being accepted, then you should hire a workers’ compensation attorney. They will know the ins and outs of the process, and you can give them permission to act on your behalf, effectively turning all of their insight and knowledge into your own.
If you think you need help with a workers’ comp claim denial or appeal, the Law Offices of Wax & Wax can help. From our offices in Santa Clarita, we assist workers’ comp clients throughout the region. Please feel free to contact us today to learn more about our services.
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"You’re a rare breed!"A lawyer with a heart who seemingly can awaken a similar characteristic in the insurance company.- Jeff
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"He won my workers' comp case!"They were always warm and professional.- Maureen
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"Wax and Wax are true professionals!"They helped me make the right decision.- Jonathan
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"s soon as he took on my case, my stress was lifted and Mr. Wax dealt with all the communication and negotiations."I was dealing with my worker's compensation case on my own and I found it confusing and overbearing at times. I met with Alan Wax from The Law Offices of Wax & Wax and I was instantly put at ease. Mr. Wax has been in this business for a very long time; he knew exactly what doctors I needed to see and how to move forward to negotiate my case against the adjusters. He not only advised me for better offers on my case but he demanded I receive all of my doctor requests from the adjuster. As soon as he took on my case, my stress was lifted and Mr. Wax dealt with all the communication and negotiations. Thank you so much for everything! I would recommend the Law Offices of Wax & Wax to anyone and everyone!- Beverly O.
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"Robert Castillo is an excellent attorney. He went above and beyond to help me."Robert Castillo is an excellent attorney. He went above and beyond to help me. I knew I could trust and rely on him. Mr. Castillo was kind and listened to my concerns. His expertise was essential in dealing with the challenges of Workman's Comp. I recommend him highly because he exceeded my expectations. Well done!- Char H.
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"Highly recommend for worker’s compensation!"They always filled me in on the details and explanations of everything I needed to know.- Former Client
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"Robert is your go-to attorney!"WOW! I am not just saying this - but Robert is your go-to attorney. He has been so patient and professional during my entire process. I will refer him to everyone I know. He answered all of my questions and was very honest with me. He took time out of his busy schedule to explain the process to me from beginning to end. I feel confident that he has my best interest and look forward to working with him. Thank you Wax & Wax.- Christine P.
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"I was extremely satisfied with the entire process."
I was referred to this law office by a friend of mine and I was very pleased with the results of my case due to the amazing service and advisement by my lawyer Robert Castillo. I highly recommend this law firm for any worker's compensation-related cases. I was extremely satisfied with the entire process.
- Selin M.
