WCAB | Workers Compensation Appeals Board and Claim Denials

A worker’s compensation appeal board is an administrative agency authorized and established by the state government. The Worker’s Compensation laws that provide protection to injured workers create these administrative boards. The laws delegate authority to the Worker’s compensation appeals boards to hear disputes related to worker’s compensation claims.

The exact nature of the appeal’s board varies by state. In California, for example, the worker’s compensation appeals board is made up of seven people who are appointed by the governor and confirmed by the state.

In some states there are two levels of review when a worker’s compensation claim is denied. For example, in Pennsylvania, the Bureau of Worker’s Compensation Judges hears worker’s compensation claims first. If and when claimants appeal a decision of the Bureau of Workers compensation Judges, the appeal then goes to the appeal board.

Worker’s Compensation Appeal Board – What do they do?

The exact functions of a worker’s compensation appeals board also vary by state. Their main purpose is to review denials of workers compensation claims and/or review requests for reconsideration if some or all benefits are denied.

This may include reviewing written requests appealing a benefit denial, or holding hearings to determine the appropriate course of action in a worker’s compensation case. In many states, worker’s compensation appeals boards can subpoena witnesses and/or compel claimants to undergo physical exams. They may also review the reasonableness of attorney’s fees when a case is decided.

Typically, the decision of a worker’s compensation appeals board is binding. Most states do provide some degree of judicial review in the case of misconduct on the part of the appeals board. However, this review is designed to ensure that the appeals board complied with administrative and substantive policies and procedures (in other words, that they followed the law correctly). If the appeals board makes a reasonable decision, typically that decision is binding even if you don’t like the decision.

Contacting the Worker’s Compensation Appeal Board

The exact procedure for contacting the Worker’s Compensation appeals board also varies by state. When you receive a denial of benefits letter or partial denial of benefits letter from the worker’s compensation insurer, the letter will contain instructions explaining how to appeal a denial of benefits. These instructions should provide details on filing an appeal and on the deadlines required to do so.

In most states, the information for contacting a Worker’s Compensation appeals board and/or filing an appeal is posted on State Government websites. These websites can be accessed by looking up the appropriate worker’s compensation board for your state.

In most cases, a written notice of appeal must be sent to the worker’s compensation board. Often additional state specific forms must also accompany this written notice of appeal. These forms can be obtained by downloading them from the appropriate state websites, or visiting a district office in your state. An experienced worker’s compensation attorney can also help you determine which forms are required.

How Can A Lawyer Help?

Filing an appeal can be complicated, and is time sensitive. If you do not file the appropriate documents with the appeals board within the legally mandated time frame, you may loose your right to appeal a denial of benefits. An experienced worker’s compensation attorney can help you to ensure that you comply with all legal requirements for filing an appeal.

A worker’s compensation attorney can help you contact the appeal’s board, and determine what evidence and forms must be submitted in order for the board to hear your case. Your attorney can also help you assemble expert witnesses and investigative materials to help prove your claim to the appeals board.

Have a Work Injury Case?