In our last post, we began discussing in general outline the claims process associated with workers’ compensation, putting particular emphasis on the need for injured workers to understand their obligations in the claims process to ensure they can claim the benefits to which they are entitled.
When an injured worker disagrees with a decision made with respect to his or her claim, he or she has the right to dispute the decision. Once a claim comes into dispute, the employer’s insurance carrier is required to inform the Workers’ Compensation Board, as well as the claimant and his or her advocate of the specific reasons workers’ compensation payments are not being made. When the reason for denying the claim is that the employee didn’t notify the employer in a timely manner, notice may be filed within 10 days of learning of the incident.
An injured worker is able to challenge a workers’ compensation decision by filing for a hearing before a Workers’ Compensation Law Judge. This gives the worker the opportunity to present testimony and medical evidence to establish entitlement to benefits. Having an advocate in the process can help an injured worker to build the strongest possible case.
Beyond the hearing, a worker is able to file an appeal within 30 days of the hearing decision if he or she disagrees with the outcome. This puts the case before a panel of three members of the Workers’ Compensation Board, which can either affirm, rescind or modify the Judge’s decision or send the case back to the Judge to further develop the record in the case. When the panel doesn’t reach a unanimous decision, a full Board Review may be requested.
Not many workers’ compensation cases go beyond this level, but it is possible to appeal cases even further to the Supreme Court. Such cases are very rare, and it is critical to work with an experienced advocate when the appeals process goes that far.