When you are seriously injured and out of work for weeks, months, or indefinitely, you may still find yourself facing a denial of your claim by your employer’s claims adjuster or their insurance provider. When you cannot resolve the denial by correcting a procedural error or providing more documentation in support of your original claim, your best and only option may be to pursue a formal appeal.
There are multiple stages to the workers’ compensation appeals process, each of which may require a unique strategy to increase the odds of a positive outcome for you as the injured worker. This is not something you want to try handling without a skilled workers’ compensation attorney on your side, particularly an experienced Tulare County workers’ compensation appeals lawyer who has helped people like you successfully through these cases in the past.
Someone who wants to appeal a workers’ compensation claim in Tulare County must first file a completed Application for Adjudication of Claim form with the county Division of Workers’ Compensation Office, usually with supporting evidence that a skilled attorney can help compile and organize.
Once the DWC office has processed the form and assigned the injured worker a case number, the injured worker can file a Declaration of Readiness to Proceed and get a hearing scheduled.
Typically, this will specifically involve requesting a Mandatory Settlement Conference (MSC) where a judge will preside over a meeting between the injured party, or the appellant, and their claims adjuster to hopefully reach a fair settlement agreement. Appellants also have the option to request reevaluation from a qualified medical evaluator (QME) or an agreed medical examiner (AME) whose reporting could have a significant impact on the outcome of a hearing.
When a settlement agreement cannot be reached during an MSC, the next step is a trial before a different judge, which may involve witness testimony for both parties. When the verdict passed down by the judge—typically within 30 to 90 days of the trial’s conclusion—is unfavorable, the appellant may file a Petition for Reconsideration with the Workers’ Compensation Appeals Board (WCAB) within 20 days of receiving notice of that ruling, which will result in a WCAB commissioner possibly reviewing their case within 60 days.
An unfavorable decision from the WCAB could then be appealed to a California Court of Appeals through a Writ of Review, and then finally to the California Supreme Court if the Court of Appeals also rules against the appellant. This is a significantly complicated and expensive step to take and it is always worth discussing this option with a workers’ compensation appeals lawyer in Tulare County before trying to pursue it alone.
The workers’ compensation appeals process may take many turns, and there are lots of small decisions, negotiations, and alternative paths to resolving your claim. No matter what, assistance from legal counsel can prove vital to achieving the best possible outcome for your unique claim. The lawyers at our firm are experienced in such cases and can help advocate for you.
A Tulare County workers’ compensation appeals lawyer could be an irreplaceable ally both in and out of court when you need to challenge a workers’ compensation claim denial. Contact us today to schedule a consultation.
