Who hears your claim if it is denied?

Many workers' compensation claims are relatively easy to substantiate and therefore are easily approved. But for certain injuries, like illnesses that built up over time due to exposure to dangerous substances, proving a connection can sometimes be difficult. This is especially true if you smoked or have other lifestyle factors could contribute to your illness. In these cases your claim could be denied. This article will go over the workers' compensation appeals board and how it reviews your case.

If your claim is denied, it is heard by the Workers' Compensation Appeal Board. The WCAB is the final adjudicative body that will hear your claim before you seek assistance from the traditional court system. It takes cases that are appealed up from the Workers' Compensation Judge that would have heard your claim.

At the conclusion of your hearing, your case is assigned to an individual Commissioner who prepares the opinion and renders a decision. The WCAB is limited in its scope of review, unlike the lower judge. The WCAB can only review a decision for the following issues:

  • Mistake in application of law.
  • Abuse of discretion.
  • To confirm that factual findings are supported by evidence.

This means that you cannot introduce new evidence to the commissioner unless you can show it would have been introduced before but for the lower judge's error or judicial abuse.

If your workers' compensation claim is denied at the initial review stage, then you may want to speak to an attorney. The appeals board allows you to present evidence and make arguments in your favor; however, it is still a daunting process. Attorneys deal with these issues every day and can help you collect your thoughts and evidence so that you present the best possible positions to the appeals board.

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