When a workers compensation insurance claim filed with the insurance company is rejected the Workers’ Compensation Appeals Board (WCAB) can be your next destination. It is considered as the judicial arm of the workers compensation insurance system in California. The Board is located in San Francisco with seven commissioners serving in it.
In spite of common perception a great deal of claims filed by injured employees never get a chance to come before the appeals board. Generally after filing an insurance claim the injured employee gets sufficient medical treatment to heal and returns back to work.
In many cases an arbitrator can work with both the employer and the injured employee to reach a mutually agreed consensus offhandedly. This informal approach resolves most of the disputes regarding types of medical treatment temporary or permanent disability levels and benefits. However when such informal resolution is not possible the injured employee or his or her attorney can file a dispute before the Workers’ Compensation Appeals Board (WCAB) in the following steps:
â€¢ Completing an application for adjudication of the claim is the first step. The next step is recommendation of the application to the respective department of the Workers’ Compensation District Office (DWC) for adjudication. At the DWC Office the disputed case is heard and decided by the Workers’ Compensation Administrative Law Judge (WCALJ). Medical practitioners may also request the adjudication of the claim if they think that the compensation received is insufficient to reimburse their services.
â€¢ After the case goes to hearing in court the judge renders his opinion in writing. Furthermore the judge appraises the proposed compensation in terms of fairness and compliance with the regulation and evidence.
â€¢ If any of the parties is not satisfied with the judge’s decision he or she may file an appeal with WCAB. This appeal shall be called a petition for reconsideration. The WCAB holds the authority of either accepting or denying the petition for reconsideration.
â€¢ The seven commissioners of WCAB then review the trial record to determine whether the administrative law judge “WCALJ” adequately inferred the evidence and appropriately applied the law or regulation. After interpretation of all the facts and findings WCAB decides the case in an unbiased manner.