Hearings and Appeals
Getting hurt at work is awful. You are likely in a ton of pain and anguish. When you look to workers’ compensation to help, you expect it to do just that. However, claims get denied all the time. Our California workers’ compensation lawyers are here to help you through the next phase.
What Happens When the Claim is Denied?
You can bring your claim forward in the hopes of receiving workers’ compensation. They are allowed to say no to you, however. You are then permitted to file an appeal against the denial of your original claim.
You can either do that in person or through mail. Be sure you get the correct documents. Our California workers’ compensation lawyers can assist with this.
The documents you need are:
- Bills for medical treatment you have yet to pay
- Your medical records
- Names and statements from witnesses
- Any other relevant document recording the injury
You need to put the insurance company on notice as soon as you have sent out your documents. This can happen via post.
Two things may happen. Your claim can be denied for various reasons. In this case everything will be sent back to you with a reason why it was denied. You are then permitted to try to file again.
Or you will have your claim accepted and a conciliation meeting will be set up. These meetings are held if there is a dispute to resolve.
Basic Information about Hearings and Appeals
When someone gets hurt in the scope of their workplace, they can file a claim to get workers’ compensation that covers their injury-related damages. Those damages can include your medical treatment and lost income.
Employers are supposed to have workers’ compensation in place. This is insurance that they purchase to cover accidents just like the one you are suffering through. Your employer may be in serious trouble if they do not have workers’ compensation insurance for their employees. Again, the insurance company that represents your employer is entitled to deny claims, which you likely already know.
Filing a claim for workers’ compensation can be a bumpy road. As with anything else, you can face obstacles and challenges. When a claim is denied, we hope for the best case scenario. It may be a mistake with the claim itself that can be easily fixed, such as a missed signature. You may, however, be experiencing something worse. Not every claim gets accepted by the insurance company in a simple and efficient way. Sometimes we have to push back when they try to turn you away deliberately.
Your California workers’ compensation lawyers can walk you through what is to come.
The Conciliation Process
Here are the four steps for reaching an agreement for workers’ comp, if you’re denied the first time:
- Reviewing board
First, you take part in the conciliation, a meeting that is held between you, your California workers’ compensation lawyers, an attorney rep for the insurance, and a conciliator. The conciliator is there to help negotiate, and serves as a neutral party between you and the insurance.
Be sure you have any necessary documents before you go to this meeting. If an agreement is not met, then you move onto the next step.
The Conference Process
This is the step that happens if you cannot meet an agreement in conciliation. It is sometimes called a proceeding. This time the same parties are meeting in front of a judge instead of a conciliator.
This judge is granted more powers and, therefore, can force the insurance company to cover you for your damages. If this is a good bet, you have to file your appeal. This brings us to the next step in the process.
The Hearing Process
This is a formal proceeding. It is a lot like a trial. There will be a judge present and you must present evidence.
There will be a presentation of evidence from both parties. You may have witnesses come and testify. If the judge’s decision is opposed by either party, the next step is to appeal to the Reviewing Board.
The Reviewing Board Process
At this point, no new evidence is allowed to be brought forward. During this phase, both parties are going to bring an argument forward to the Reviewing Board.
In essence, you state your claim and your California workers’ compensation lawyers will argue your legal case for you.
Hopefully at this point, a fair conclusion is brought forward. If not, either party is allowed to appeal to state court. This, however, is rare.
Call a California Workers’ Compensation Lawyers Today
If you have not been given workers’ compensation and you have questions about the hearings and appeals process, please contact our California workers’ compensation lawyers today for a consultation.