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Appealing a Denied Workers’ Comp Claim

Appealing a denied workers’ comp claim in Massachusetts can be difficult without the legal counsel of an experienced Lowell workers’ comp attorney. Here is what you need to know about the various steps in the claims disagreements process.

Appealing a Denied Workers’ Comp Claim | Conciliation

Conciliation consists of an informal meeting between the worker, the worker’s attorney (if he or she has one), an attorney for the workers’ compensation insurance company and the DIA conciliator. The conciliator serves as a neutral third party to try and help negotiate a settlement.

Conciliation meetings take place at the closest DIA regional office to the employee. If the worker is out-of-state, the conciliation will automatically take place in Boston. In some circumstances, the location of the conciliation meeting can be changed.

Appealing a Denied Workers’ Comp Claim | Conference

The second step is the conference (sometimes referred to as a proceeding). And while the worker still isn’t required to have an attorney, it’s strongly recommended they have an experienced workers’ compensation hearings and appeals attorney with them for this process. This is because even though a conference is an informal meeting between the workers’ compensation insurance company and the worker, instead of being before a conciliator, it’s in front of an Administrative Judge.

This Administrative Judge has much more power than the conciliator because the Administrative Judge can make a decision as to whether the workers’ compensation insurance company must pay benefits to the worker. If the worker or the workers’ compensation insurance company disagrees with the Administrative Judge’s order, they must file an appeal within 14 days. Appeals are decided at a hearing.

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Appealing a Denied Workers’ Comp Claim | Hearing

A hearing is a formal legal proceeding and is a lot like a trial. A hearing is held before an Administrative Judge and many rules from a regular courtroom apply, such as the Massachusetts rules of evidence.

At the hearing, both sides present evidence in support of their position and may call witnesses to testify. In certain situations, either side may be required to submit new evidence before the Administrative Judge issues a decision. If either side is unhappy with the Administrative Judge’s decision, they can appeal it to the Reviewing Board.

Appealing a Denied Workers’ Comp Claim | Reviewing Board

At this level of the workers’ compensation settlement process, the parties may only present legal arguments in support of their position. Generally speaking, no new evidence may be presented to the Reviewing Board. If the Reviewing Board feels additional evidence is necessary, they will usually remand the case back to the Administrative Judge for further consideration of additional evidence.

No matter what, the parties must present legal briefs to the Reviewing Board. These legal briefs will explain the basis for their legal position. The Reviewing Board will sometimes ask for more from the parties, such as coming before the Reviewing Board to present their legal arguments in person. If either side is still unhappy with the Reviewing Board’s decision, they may file another appeal with the Massachusetts Court of Appeals.

If you are refused workers’ compensation benefits, all is not lost. To learn more about appealing a denied workers’ comp claim, please contact our office for a consultation with a dedicated Massachusetts workers’ compensation hearings and appeals attorney. Let our experience work for you.

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