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How the Workers’ Comp Appeals Process Works

Workers’ comp benefits are available to employees who suffered injuries and illnesses in the workplace without regard to fault. To be eligible, a company must provide these benefits through worker’s compensation insurance. If your employer’s insurance company denied your benefits claim for a work-related injury or illness, it’s important that you know how the workers’ comp appeals process works.

Appealing benefits claim decisions can be complex and time-consuming. While you can appeal it on your own, hiring a lawyer to navigate this important process can be beneficial. Our workers’ comp lawyer can determine why your claim was not approved and build the strongest possible case for receiving or reinstating benefits. They can also explain the appeals process and fight hard for the medical care and financial compensation you need and deserve. Call KJT Law Group at (818) 507-8525 today for a free consultation.

First, You Must Understand Why You Received a Workers’ Compensation Claim Denial

Building an effective appeal starts with understanding why you received a denial of workers’ compensation benefits. Reasons workers’ comp claims get denied include:

  • Your injury was per-existing, and your job did not worsen it.
  • Your injury was not work-related or did not happen during work activities.
  • Your injury occurred while working for another job and employer.
  • Your injury was not severe enough to warrant medical care.
  • Your injury did not require three or more days of absence from work.

If you seek legal representation, bring a copy of your letter of denial to your workers’ comp lawyer. They will review its content and craft a response, including compiling additional evidence and consulting relevant medical professionals and other experts.

Understanding Each Step in the Workers’ Comp Appeals Process

Just like applying for benefits, filing an appeal starts with paperwork. If a lawyer represents you, they will obtain, complete, and file the appropriate workers’ compensation forms. They will also file your appeal request in the appropriate county office and serve it to the claim administrator or other appropriate party. Once they file your application:

  • You will receive a notice confirming the filing of your appeal.
  • You will be assigned an appeal case number.

Your attorney can request a hearing before a workers’ compensation judge. They will file the form required for this next step. At your hearing:

  • A judge will hear you and any supporting witnesses.
  • The judge will ask questions and attempt to find a mutually agreeable resolution.
  • If an agreeable resolution is unreachable, you may have to take your case to trial.

If your case goes to trial, your lawyer will represent you. The appeals trial will take place in front of a different judge, and your attorney will provide evidence and exhibits to prove your case. They also will prepare you and others to testify on your behalf. After this proceeding, a written determination can be made within 90 days.

Your lawyer will update you at each phase of the appeal. Meanwhile, you can concentrate on getting better so you can return to work. Your lawyer will explain everything you must know about the appeals process and getting your benefits.

How Long Do Workers’ Comp Appeals Take?

Filing a workers’ compensation appeal can take time. Even before your lawyer files an appeal, they will review your denial letter to understand the reason for your appeal. Depending on the reason, it can take time thoroughly investigate your claim and prove you are entitled to benefits.

  • Your appeal must be filed within 10 or 20 days of the denial (depending on certain circumstances)
  • The appeals board can approve reconsideration within a 60 days.
  • A workers’ comp judge can approve reconsideration within 15 days.
  • The Workers’ Compensation Appeals Board (WCAB) has up to 60 days to act on your petition to appeal.

Processing an appeal, from start to finish, could take several months. On your own, the workers’ compensation appeal process could take longer than it would if a lawyer was handling your appeal. A lawyer can explain the process and help you understand how it works.

How Long Does It Take to Start Receiving Benefits After a Successful Appeal?

Medical care for work-related injuries or illnesses should start immediately upon notifying your employer. Do so promptly to avoid any delays in getting the treatment you need.

You must be injured or ill and miss at least three workdays to qualify for workers’ comp benefits. Once the required period ends and your application or appeal receives approval, you should generally start to receive benefits within about 14 days. This does not include the time it takes for your check to arrive in the mail.

Get Our Client-Focused Workers’ Comp Team Behind Your Fight for Benefits

You do not have to give up on getting medical and financial benefits if you were hurt at work and your workers’ compensation benefits claim was denied. At KJT Law Group, our workers’ comp attorney will explain how the workers’ comp appeals process works.

You can learn more about how we can help you with your next steps by contacting our benefits appeal team at (818) 507-8525 today.

We Will Fight For You

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