Wakefield, MA Lawyer for Appealing a Workers’ Compensation Claim Denial

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When you are injured at work, you expect that the workers’ compensation system will provide you with benefits while you are unable to perform your duties. However, you may quickly learn that insurance companies routinely deny or reduce legitimate workers’ compensation claims to safeguard their profit margins. In this situation, appealing a workers’ compensation decision in Wakefield may become a necessity.

Navigating the appeals system through the state Department of Industrial Accidents (DIA) is rarely a straightforward or easy task. You may find it even more challenging to handle these matters when you are struggling to recover from work-related illness or injury. a skilled injury attorney may be instrumental in helping you get the benefits you deserve.

Appealing Denied Claims with a Wakefield Workers’ Compensation Lawyer

After the Employee files a workers’ compensation claim, the first step in this often-lengthy process is for the parties to attend an informal meeting or Conciliation with a DIA Conciliator. One purpose of the Conciliation is to ensure that there is adequate medical evidence for the dispute to move to the next stage of the appeals process. However, Conciliators also may try to resolve the conflict between the parties.

The Massachusetts Department of Industrial Accidents (DIA) handles disputes arising from workers’ compensation claims, whether they are denials or terminations of claims. Employees who disagree with the decisions that they have received from the insurer may file a claim, and a DIA Administrative Judge will review the matter and may order the insurance company to pay workers’ compensation benefits. The formal review process contains several different steps before the DIA decides the dispute based on its review.

Parties to a workers’ compensation dispute must first attend a Conciliation with a DIA Conciliator which is an informal meeting to ensure that the medical evidence supports the claim and, also, to see if the insurer will reconsider its denial or termination and agree to pay workers’ compensation to the injured worker. Upon hearing evidence and arguments from both sides, the administrative judge would issue a Conference Order. The insurer or the employee then is likely to request further review of the order through the appeals process. Due to the complex nature of these appeals that are subject to various deadlines, injured or ill workers with workers’ compensation claims may wish to consult with legal counsel for advice.

If an agreement cannot be reached and the Conciliation is unsuccessful, DIA assigns the case to an Administrative Judge for a conference. at this conference, the attorneys for each side present evidence and make arguments in support of their respective positions. The judge issues a Conference Order as a result of the conference.

Either or both parties may appeal the Conference Order if they disagree with any aspect of it. If the case involves a medical dispute between the employee’s doctor and the insurance company’s doctor, the employee will have to attend an impartial medical examination with an impartial doctor selected by the DIA. After the impartial doctor files the impartial report, the case will be scheduled for a Hearing with the same Administrative Judge. Legal counsel may be able to assist injured workers throughout every step of their workers’ compensation appeal.

Conference Orders in a Workers’ Comp Case

If one or both parties appeal the Conference Order, the case moves to the “trial” phase or a full evidentiary hearing. This phase of the appeal is a more formal hearing at which the state rules of evidence apply. The Administrative Judge hears evidence, including documents, records, and oral testimony, and may request new evidence from either party before issuing a decision.

Next, one or both parties may choose to appeal the decision after trial to the DIA Reviewing Board. This body of three administrative law judges can examine hearing transcripts and request legal arguments and legal briefs. The Reviewing Board would ultimately affirm or agree with the decision or send it back to the Administration Judge for further findings of fact.

Appealing a Wakefield workers’ compensation decision can be challenging, particularly at the Reviewing Board level. The Reviewing Board would not hear new evidence and will reverse the decision only in specific circumstances, such as if the decision contained an error of law.

Court Appeals of Workers’ Compensation Claim Decisions

Additional appeals beyond the Reviewing Board fall outside the DIA administrative appeals system. at this level, claimants must appeal their claims to the Massachusetts Court of Appeals. on rare occasions, a case could even go before the Massachusetts Supreme Judicial Court.

Once an appeal reaches this stage of the appellate process, the delays are lengthy. As a result, seeking the assistance of legal counsel from the outset of a claim denial or benefits termination may be wise. Individual claimants may increase their chances of a favorable result by having legal representation as early as possible during the administrative appeals process.

Talk to our Wakefield Attorney for Appeals of Workers’ Compensation Claims

The multilayered nature of appealing a workers’ compensation decision in Wakefield is complex and challenging to navigate on your own. State law also establishes multiple deadlines for continuing with the appeals process that claimants must follow to preserve their claims. Attempting to appeal your claim through the different stages of administrative appeals can be impossible to manage without the assistance of an experienced workers’ compensation lawyer. For more information, schedule a consultation today at (617) 925-6407 with our Boston workers’ compensation appeals lawyers.