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Understanding the Workers' Compensation Appeals Process

Because workers’ compensation insurance is a business, workers’ compensation insurance companies will look for any way possible to minimize their expenditures when it comes to paying workers’ compensation benefits. In many cases, this comes at the expense of the health or overall well-being of the person the benefits were awarded to.

There are a number of ways in which an insurance company can go about this. For example, they may suggest or require that you see one of their “approved” doctors for a medical evaluation. This doctor will then give you a less-favorable evaluation, which then can result in you being denied the compensation and treatment you need. To make things even worse, the company may refuse your request for a re-evaluation and attempt to close your claim.

Because of situations like these, the state of California has created a special legal body whose sole purpose is to mediate these contested claims, known as the Workers’ Comp Appeals Board (WCAB). This seven-member board will then hear your case and determine whether the award you were issued was fair, and if not, what a fair reward should be.

How to File a Workers’ Compensation Appeal

In order to start the formal appeals process, you must first file a document called a “Petition for Reconsideration” at your local district office of the WCAB. This must be done within 20 days of the initial award decision. You may also choose to do this as a result of new evidence emerging that could not have been considered at the time of your initial award (such as a relapse of a condition). A workers’ compensation attorney can help you do this properly, as well as consider whether any new evidence can be added to your case.

Once you file, the appeals board has 60 days to decide whether or not they will consider your case. If they agree to consider it and you have new evidence, they must hear it and will schedule a new hearing. The board will choose to affirm your reward, reject your reward all together, or amend your original decision. You will be notified by mail as to the final decision.

If either you or the insurance company do not agree with the decision, it can be appealed further to the State Appellate court by filing a “writ of review.” The appellate court cannot do much—their jurisdiction is limited to determining whether the decision was reasonable or not, they cannot modify an award decision in any way.

How Can We Help?

If you would like to pursue a workers’ compensation claim appeal, it is important to retain legal counsel for the process to help ensure all evidence is considered and you receive the maximum award you are entitled to. The skilled Central Valley workers’ compensation attorneys at Berry, Smith & Bartell, a Professional Law Corporation may be able to help you with your case. We have over 60 years of combined experience, and use a compassionate, understanding approach to provide our reliable legal representation. We serve our clients throughout California’s Central Valley out of our offices located in Bakersfield, Fresno, and Santa Maria.

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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