When Will the Workers’ Compensation Appeals Board Review a Denied Claim?

 Posted on February 25,2022 in Workers' Compensation

For those who are injured while on the job, workers’ compensation can provide essential benefits, ensuring that their medical care will be paid for and that they will be compensated for some of the income they have lost. However, there are some situations where workers’ comp claims may be denied. In these cases, injured workers will need to understand their options for filing an appeal, including when their case may be heard by the California Workers’ Compensation Appeals Board (WCAB).

Requests for Reconsideration Before the WCAB

While all work-related injuries should be covered by workers’ compensation, regardless of who was at fault, there are a variety of reasons why a person may be denied benefits. An employer or their insurance company may believe that a person’s injuries were not work-related, or they may claim that certain types of medical treatment are not necessary. Disputes may also arise regarding whether an injury has resulted in a disability, and a worker may be denied temporary or permanent benefits that should address the loss of income they have experienced.

If a workers’ compensation claim is denied, a person will need to go through a specific process as they respond to this denial and request a review of their case. In some cases, a person may be able to resolve disputes by working with their claims administrator, or they may be able to negotiate a settlement with their employer. If a case cannot be resolved through these methods, a trial may be held before a workers’ compensation judge, who will review evidence and testimony and make a decision about whether benefits should be granted.

If a workers’ compensation judge renders an unfavorable verdict, a person may file a request for reconsideration with the Workers’ Compensation Appeals Board. The grounds for reconsideration include:

• A workers’ compensation judge made certain decisions when they did not have the power to do so.

• A judge’s decision was based on fraud (such as bribery).

• The evidence provided in a trial did not support the judge’s decision.

• New evidence has been uncovered that was not available at the time of the trial.

After reviewing a request for reconsideration, the WCAB may choose to grant reconsideration, or it may deny or dismiss a petition. A petition may be dismissed if it was not filed within the required time limits or did not meet other legal requirements. If a petition is denied, the WCAB may accept the judge’s opinion and recommendations, or it may provide its own opinion for why the claim should be denied.  If reconsideration is granted, the WCAB may rescind the judge’s decision and order a new trial or other proceedings to gain the necessary information about a case, such as new medical examinations. 

Contact Our Santa Clara County Workers’ Comp Appeals Attorneys

If your workers’ comp claim has been denied, Cramer + Martinez can help you determine your options for appealing this decision. We will fight to make sure you receive the benefits you deserve that will fully address the effects of your work injuries. Contact our Morgan Hill workers’ compensation benefits lawyers at 408-848-1113 for a free consultation.

Sources:

https://www.dir.ca.gov/wcab/about_wcabf.htm

https://www.dir.ca.gov/wcab/about_wcabp.htm

https://www.dir.ca.gov/dwc/MyClaimWasDenied.htm