When to Appeal to the Workers Compensation Board

The workers compensation board is the administrative board in your state that enforces workers compensation legislation. When each state passed the workers compensation statute providing protection for those who suffer injuries at work, it created a workers compensation board to oversee and manage the workers compensation laws. When an individual who believes he is entitled to workers compensation is denied benefits by his employer or his employer's insurance company, then that person can appeal to the workers compensation board.

Workers Compensation Board Appeals

After you suffer an injury at work, workers compensation is your exclusive or sole remedy against your employer. This means you cannot sue your employer. However, in some ways workers compensation is supposed to provide you with broader protection for work injuries, since unlike in a traditional personal injury lawsuit, you do not need to prove that your employer was negligent in order to recover your damages. All you must prove is that your injury happened because of work (not necessarily at work, you can be compensated for injuries that happen anywhere, as long as they resulted from fulfilling work duties) and that you weren't expressly violating company policies or under the influence of alcohol or drugs when the injury happened.

When you file a workers comp claim, you usually file by notifying your employer of the injury within several days of the accident. You must provide medical documentation and a description of when and how the injury happens. If your claim is denied, then you need to take steps to appeal that denial. Since workers comp is an exclusive remedy, if you don't appeal, you'll be left without any means of recovering your benefits. Generally, to appeal:

You must initially file a written request for appeal with the insurer who denied you benefits. If they requested any additional information or you have additional evidence, be sure to provide it
If your request for reconsideration is denied, you usually can file an appeal with the workers compensation board. Depending on your state, there may be several levels of appeal with the board. They may first review the written documentation and then if that appeal is denied you may be granted a hearing, or you may go straight to the hearing.
If your claim is still denied after an appeal to the workers comp board, you may appeal in federal appellate court, but the court is very deferential to the workers comp boards decision and will only overturn if there was some procedural error, the courts won't change findings of fact.

Getting Help

If you have a workers comp claim, you should have a workers comp attorney. Your lawyer can help you to minimize your chance of denial on the initial claim and, should the initial claim be denied, can assist you in going through the process of an appeal.

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