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Denied workers' compensation and grounds for reconsideration

Since workers' compensation can be such a necessity for California workers who have suffered a workplace injury, a denied claim can lead to great uncertainty for the future. People who have had their workers' compensation claims denied often do not realize that they can take steps to try and get a reconsideration of the decision from the Workers' Compensation Appeals Board. This is even true after a judge has decided the case and denied the claim. People who are confronted with this problem should be aware of their rights to seek reconsideration and what the grounds are for doing so.

The WCAB can hear a case whenever it decides to and take the case from a judge. It will generally act only after the workers' compensation judge has decided. This is the definition of its reconsideration process. It is only possible for a final order to be subject to reconsideration. This can only be granted on its own motion within 60 days of the final decision having been filed. Most often, it will act when a party has filed a petition.

The aggrieved party can file the petition for reconsideration within 20 days after the decision was served. There are five grounds for reconsideration: the appeals board or the judge acted beyond its power; the decision was made based on fraud; the decision was not justified based on the evidence; new evidence had been discovered and it could not be provided when the hearing was held; and the findings of fact do not justify the decision.

The workers' compensation judge will have 15 days from the date of the petition to formulate a report and make a recommendation to the appeals board regarding the judge's decision. The decision can be amended, modified or rescinded during that period. If it is rescinded, it can be done so further proceedings can be held. From the time of the filing, the appeals board must act within 60 days. If it does not, the petition is automatically denied.

These issues might be confusing to a worker who is already concerned about a denial of workers' compensation benefits. From the beginning of the case and throughout, it is imperative to have legal assistance. This is especially true when appealing denied claims.

Source: dir.ca.gov, "Organization and Functions," accessed on April 9, 2018

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