What is the Worker’s Compensation Appeals Board?

As you work with your San Jose worker’s compensation lawyer to get the outcome you deserve, you may hear mention of the Workers’ Compensation Appeals Board. This board is not something you will likely come across in everyday life, but it is worth learning about if you are currently seeking compensation for workplace injuries.

What Is the Workers’ Compensation Appeals Board?

The Workers’ Compensation Appeals Board is a judicial body that reviews any petitions that have been filed to reconsider a worker’s compensation. According to the California Department of Industrial Relations, this body also regulates the adjudication process by adopting procedure and practice rules.

When you contact a workers’ compensation lawyer to represent you as an injured employee, they practice law before this very same board. Their job is to assist you in receiving compensation for leave taken from work, medical bill payments, retraining in new positions, and other benefits.

What Can the Workers’ Compensation Appeals Board Do for a Worker?

Each workers’ compensation appeals board throughout the country, including California, has seven governor-appointed members that are certified by the Senate. This body can exercise its powers to review petitions, including those regarding benefits received by workers who have been injured or struck down by an illness related to their workplace.

When an injured worker and the workers’ compensation insurance company can’t agree on the outcome of compensation and benefits for an injury or illness, they can take their dispute to the Workers’ Compensation Appeals Board.

A judge with the board sets a hearing with the goal of resolving disagreements around claim denial, disability rate disputes, and more. During the trial, all of the evidence is laid out for the judge to see, including witness testimonies where appropriate.

The judge reviews the information and makes a formal decision that officially resolves the dispute. However, neither party has to accept that decision. Instead, the worker or insurance company can appeal it by filing a petition for reconsideration with the commissioner of the Workers’ Compensation Appeals Board. This sees the beginning of a multi-step process to potentially change the outcome for the worker.

What to Expect During A Workers’ Compensation Appeal

We’ve talked about the general process of obtaining workers compensation payments when your employer, its insurance carrier, or your state’s workers compensation board refuses to pay out of pocket. Now, let’s take a deeper look at the Workers Compensation Appeals Board:

1. Your appeal is reviewed by the Workers Compensation Appeals Board.

The Workers Compensation Appeals Board will evaluate your appeal and any supporting material you supply if you file it on time. It’s critical to supply as much correct information as possible so that the Workers Compensation Appeals Board has all it needs to evaluate your claim and reverse your benefit decision.

2. Your Employer or the Insurance Company Will State Their Position

Your employer or its insurance carrier (or your state’s workers compensation board) will have the option to respond after you file an appeal. When rendering its decision, the Workers Compensation Appeals Board will consider any evidence provided by these entities.

3. At a hearing, both sides’ attorneys present their arguments.

The Workers Compensation Appeals Board will usually schedule a hearing once both sides have presented their evidence. Your attorney and the attorneys for the other side will submit their cases to the court or commissioner at this time.

4. California’s workers compensation law is applied by the judge or commissioner.

After evaluating the facts and hearing both parties’ arguments, the judge or commissioner will decide based on California’s workers compensation statute. Your denial of benefits may be reversed or confirmed because of this decision.

5. You Find Out the Results

Workers Compensation Appeals Boards might take several weeks to reach a decision, so you may not find out the results of your appeal immediately. However, you should receive a decision shortly after your hearing, and you may then decide what steps (if any) to do next.

This is merely a high-level description of the workers’ compensation appeals procedure and if you need to file a federal workers’ compensation appeal with the ECAB, the process is different. You should speak with an experienced Orange County workers’ compensation attorney as soon as possible to learn about the precise actions you need to do to appeal your workers compensation denial.

Filing a Petition for Reconsideration

If your workers’ compensation lawyer believes a petition for reconsideration is in your best interest, they will help you file it. This petition goes before three Workers’ Compensation Appeals Board commissioners who review the judge’s decision and the case facts that led to it.

Each commissioner has a right to make their own decision on the case, which they then deliver to the appeals board for a written order. This order may be for a reconsideration request to be granted or for the petition to be dismissed. If a reconsideration request is granted, the judge is given the opportunity to review it further. This is the last step towards any final changes being made or the initial decision upheld.

Obtaining Legal Assistance

To make an initial appeal, you can seek an information and assistance officer at your local district worker’s comp office for help submitting a Petition for Reconsideration. Or, you can hire a workers’ comp attorney to file the Petition for Reconsideration for you. However, without a solid case, you may have a difficult time obtaining an attorney to defend you at the appeal stage if you haven’t been represented by an attorney previously.

If you’ve already filed an initial appeal and want to file a petition for writ of review with the appellate court or an appeal with the California Supreme Court, you’ll almost certainly need the assistance of a worker’s compensation attorney—this is well beyond the scope of most information and assistance officers’ expertise.

It can be hard to know where to turn when you are unhappy with how your workers’ compensation claim has been handled or resolved. You have every right to fight for an outcome you believe is fitting of your workplace injury or illness. Schedule a free consultation with a San Jose workers’ compensation attorney to find out what your options may be.