What You Need to Know About the Workers Comp Appeals Process

Every day you likely see people make decisions you wish they would reconsider. People make mistakes because they're tired, bored, angry or just plain uninterested in what's happening around them. Appeals were made for those who feel the courts were full of professionals making choices based on their own self-interests and not based on the facts.

We'll tell you what you need to know about workers who choose to go through the appeals process. 


Before You Reach the Courts 


If a doctor denies a request for treatment that an employee feels is necessary, the first step is to get a second opinion. Often this can be done through a Qualified Medical Examiner, meaning this person has undergone special training to work with injured patients on the job. However, if an employer refuses to acknowledge their part in the matter or the insurer denies their responsibility in the claim, then it may be necessary to take the matter to the courts. 


How It Works 


For some cases in workers compensation, the employer is clearly at fault, they cover the employee's injuries and insurance picks up the tab. However, other times the facts aren't so clear and the employer goes to court. Workers compensation will typically have their own judges who work to decide fair outcomes for all employees they see.

They look at the testimonies of the employee and potentially the employer, they'll gather the medical information and review all other evidence to determine what compensation should be given. Once the judge gives their decision, either the employee or the employer may appeal. In New York state, it's normally 30 days after the filing, but each state will have their own specifications.

The appeals board typically will then have the power to modify the terms of the decision, or flat-out agree or disagree with the judge. If those on the Appeals panel don't agree with each other, it will get kicked up to a higher level for a full Board review, in which case there will be another set of people who look at the facts. 


Benefits and Beyond 


You are not required to pay benefits while a case is being contested, meaning that some employers have used it to tie up funds by dragging cases out through appeal after appeal. The justice system is somewhat malleable in that cases have the ability to be pushed up the ladder until they reach the very top — especially in unique cases that haven't been tried before. If you're at a loss of what to do, remember that there are always options. However, the legal costs and hassle may not make it worth it. 

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