Workers’ compensation provides income and medical benefits to those who sustain work-
related injuries. However, many times these claims will be denied or disputed by the workers’ comp insurance company that your employer carries. You may be wondering, “Can I appeal a denied workers’ compensation claim?” If you are appealing a denied claim, you will need the legal guidance of an experienced workers’ compensation attorney.
Can I Appeal a Denied Workers’ Compensation Claim?
If a worker and workers’ compensation insurer disagree about a claim, there are four steps available to try and reach an agreement among the parties: conciliation, conference, hearing, and Reviewing Board.
Conciliation consists of an informal meeting between the worker, the worker’s attorney (if he or she has one), an attorney for the workers’ compensation insurance company and the DIA conciliator. The conciliator serves as a neutral third party to try and help negotiate a settlement.
Conference
The second step is the conference (sometimes referred to as a proceeding). And while the worker still isn’t required to have an attorney, it’s strongly recommended they have an experienced workers’ compensation hearings and appeals attorney with them for this process. This is because even though a conference is an informal meeting between the workers’ compensation insurance company and the worker, instead of being before a conciliator, it’s in front of an Administrative Judge.
Workers’ Compensation Hearing
At the hearing, both sides present evidence in support of their position and may call witnesses to testify. In certain situations, either side may be required to submit new evidence before the Administrative Judge issues a decision. If either side is unhappy with the Administrative Judge’s decision, they can appeal it to the Reviewing Board.
Reviewing Board
At this level of the workers’ compensation settlement process, the parties may only present legal arguments in support of their position. Generally speaking, no new evidence may be presented to the Reviewing Board. If the Reviewing Board feels additional evidence is necessary, they will usually remand the case back to the Administrative Judge for further consideration of additional evidence.
No matter what, the parties must present legal briefs to the Reviewing Board. These legal briefs will explain the basis for their legal position. The Reviewing Board will sometimes ask for more from the parties, such as coming before the Reviewing Board to present their legal arguments in person.
Ben Winter, P.A. focuses its practice in the areas of Social Security Disability and Workers Compensation in St Petersburg, Florida. For more information, go to our web site www.benwinterlaw.com or call (727) 822-0100.