Appealing a Workers’ Compensation Decision in Cambridge 

After sustaining an injury at work, an individual could reasonably expect to receive workers’ compensation benefits. Often, an individual’s claim for benefits may be denied for a myriad of reasons.

If you have been denied benefits, speak to an experienced attorney to learn about appealing a workers’ compensation decision in Cambridge. A seasoned workers’ compensation attorney could review your case and help you through the steps of recovering benefits.

How To Appeal

If appealing a workers’ compensation decision in Cambridge, it is important to consider the type of decision. If the decision that is being appealed is a conference order at the Department of Industrial Accidents, the injured worker has 14 days from the date of the conference order to appeal. If it is a hearing decision by an administrative judge, then the injured worker has 30 days to file an appeal to the reviewing board.

To appeal a workers’ compensation denial in Boston, the proper forms need to be completed. The Department of Industrial Accidents publishes DIA numbered forms that are used in most steps along the claims process. In case of an appeal of a conference order, there is an appeal conference form that the injured worker needs to fill out properly.

If there is a dispute that the injured worker is not injured or no longer disabled, then the appeal has to be accompanied by an appeal fee to pay for an impartial examination, which is the step between the conference and a hearing de novo. If the appeal is from a hearing decision, then there is an additional form that is filled out, and the appeal then would be sent to the DIA reviewing board. These are very complicated steps in following all the rules and procedures concerning appeals from conference orders or appeals from hearing decisions. Because of that, it is advisable that an injured worker not try to do this alone but to have an experienced workers’ compensation lawyer at their side right from the beginning.

Essential Components of an Appeal

The essential components needed to ensure that a workers’ compensation claim is successful include documentation that an injury occurred at work. In many cases, this means obtaining police reports, witness statements, photographic evidence of the circumstances of the accident, and any physical evidence of the injury.

A diligent attorney could obtain all of the medical records surrounding the injury and the follow-up treatment that the injured worker had. Also, they could collect all of the relevant medical records in the employee’s past so that a full and proper evaluation can be conducted to review what the prior condition was and what is related to the work injury. There should also be full accounting and documentation of all earnings that would be included in calculating the average weekly wage, both from the employer for whom the injured worker was working at the time of the work injury and any concurrent employers.

Denied Claims

In many cases, an injured worker can appeal a denied workers’ compensation claim. If the appeal is filed too late, then the claim will be denied. There are processes in place for petitioning to file a late appeal. That is something that is left to the discretion of the senior judge in charge of the administrative judges at the Department of Industrial Accidents. Usually, there has to be some good faith showing why the appeal was filed late and why the senior judge had allowed the injured worker to file the late appeal.

An administrative judge might deny a workers’ compensation claim if there is not sufficient evidence to prove that an injured worker sustained an injury in the scope and course of their employment. Additionally, a claim may be denied if there is not enough evidence to support that an injured worker received an injury caused by either their work activities or a specific accident at work. A claim could be denied if an administrative judge determines that the alleged injury was not related.

Claims could be denied if the injury was pre-existing, either from some other injury in the injured workers’ history, or as a result of some degenerative condition such as arthritis or bursitis. Usually, claims are denied when the administrative judge does not believe that there is sufficient evidence that the injured worker sustained an injury at work or that the injury is disabling.

How an Experienced Workers’ Compensation Attorney Could Help

A workers’ compensation lawyer will take all necessary steps and follow the procedures and rules concerning appeals at the Department of Industrial Accidents to ensure that an injured worker’s appeal is timely and properly completed. The injured worker then has the best chance of success in prevailing at the appeal. While the denial is being appealed, a lawyer keeps the channels of communication open with the insurance company to try and see if there is an opportunity to settle the claim. When available, settlements can provide some guarantee of a specific amount that the worker will receive.

Call today to learn more about how an attorney could help with appealing a workers’ compensation decision in Cambridge.