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The most important tip for filing a workers' compensation appeal is to read the notice of denial carefully and pay attention to the deadlines indicated in the notice. Although a right to appeal may be automatic, there is usually a time frame within which the appeal must be filed or the right is considered waived. In addition to the time frame for filing, the notice should also indicate to whom and how the appeal must be filed.
Although the workers' compensation system may vary somewhat by country, the basic concept is the same. Workers' compensation is intended to provide injured workers with medical coverage and a percentage of his or her wages while injured if the injury occurred on the job or is work related. A workers' compensation claim must be filed by the injured worker in order to receive benefits. If the claim is denied, the worker has the option to file a workers' compensation appeal.
The workers' compensation claim process usually starts when the worker is injured or diagnosed with an illness that he or she believes is work related. Some workers' compensation injuries are obviously job related, such as when a construction worker falls while on the job site. Other injuries or illnesses are not so obvious, such as illness caused by exposure to toxic chemicals or substances while at work. Once the claim is filed, a decision will be made whether or not to approve the claim and cover the medical expenses and lost wages of the claimant. If the claim is denied, then the claimant will be notified of the denial and of his or her right to appeal the denial.
If the claim is denied, the claimant should consider hiring a workers' compensation lawyer. In most jurisdictions, a workers' compensation lawyer is not required to file a workers' compensation appeal but one may be retained if the claimant chooses to do so. This type of lawyer understands the workers' compensation laws and the appeals process. Although hiring a lawyer may ultimately cost the claimant in financial terms, it may also put him or her in a better position to win the workers' compensation appeal.
Documenting the claim from start to finish may mean the difference between winning and losing the workers' compensation appeal. The appeal will likely be heard by an administrative law judge at an informal hearing. In order to prevail, the claimant must present documentary evidence of the injury or illness as well as convince the judge that the injury or illness is work related. Medical bills, diagnosis, and prognosis, as well as statements or testimony from witnesses may be crucial pieces of evidence for a workers' compensation appeal.
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