How to Appeal Your Workers' Compensation Claim

by James M. Hoffmann on Aug. 20, 2014

Employment Workers' Compensation Accident & Injury Employment  Employee Rights 

Summary: An injured employee can appeal a workers compensation claim if no agreement was made with the employer through a conference or mediation.

Pre-hearing

Employees can often go through a pre-formal discussion if they want an informal consultation with the insurance company of the employer. This can also be done if the employee did not undergo mediation through Dispute or Conference Management Services.

Ask for Mediation

This may be necessary whenever there are some unaddressed issues before the appeal continues or the employee does not agree with the report for final rating. It may also be necessary when the medical treatment request of the employee was not approved and the treatment was still recommended by the doctor

Ask for a Hearing

An employee can request for either of the two kinds of hearings in the appeal. These hearings are the Hardship Hearing or Final Hearing. The Hardship Hearing can be requested if a doctor indicated that the employee has not attained the maximum medical improvement or the MMI, which will require the employee to continue medical treatment or get temporary total disability benefits. The Final Hearing should be requested when the employee has attained the maximum medical improvement and the case is awaiting a final decision.

Resolution of a Hardship or Final Hearing

The two types of formal, legal hearings will be conducted by an administrative law judge. As an injured worker, it would be the wise course to get the assistance of an experienced workers' compensation attorney who can present all the necessary evidence during the hearing. Your attorney will also determine the information required for the appeal. You can be sure the other side will have legal representation, so getting an equal footing is very important.

At least one award will be rendered by the administrative law judge, a Temporary or Partial Award, Final Award, or Award on Agreed Statement of Facts.

The Temporary or Partial Award is normally issued after a Hardship Hearing. It will deal with benefit or medical treatment concerns. The case will remain unresolved until the judge renders a Final Award.

The Final Award is the final decision of the judge in connection to the issues associated with the appeal. The administrative law judge will decide on the final resolution of the case. The Missouri Labor and Industrial Relations Commission is one venue for appealing the Final Award rendered by the judge.

Labor and Industrial Relations Commission Appeal

The decision of the administrative law judge can be appealed by the employee or the insurance company within twenty days after the decision was made. An “Application for Review” should be filed to make an appeal.

The transcript of the hearing is reviewed by the Commission panel. Legal briefs should be provided by the employee and employer, and only the existing evidence is allowed. The Commission will decide whether to provide a new award or uphold the existing award.

The decision of the Commission can be appealed to the Missouri Court of Appeals, which can overturn the decision if the law was improperly applied, but will not issue a new decision. The Missouri Supreme Court is the last stage for appealing the case. However, workers’ compensation cases seldom reach this level. The Court also has the discretion to ignore appeal.

Having an experienced Missouri workers compensation lawyer by your side can help get the compensation that you deserve.

Call (314) 361-4300 for a free consultation with St. Louis workers' compensation lawyer James M. Hoffmann. With over 20 years of experience and millions of dollars actually collected, you can rest assured that when the Law Office of James M. Hoffmann takes your case everything will be done to protect your rights and get you the compensation you deserve.


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