How To Gather Evidence for a Workers' Compensation Appeal

After filing for workers’ comp, your employer can dispute your injury claim to deny giving you benefits. You have the right to file an appeal or dispute the denied claim. However, be prepared with evidence to support your workplace injury claim. It can take time to gather the evidence you need, but a lawyer can help.

Workers’ compensation laws vary by state. Talk to a local workers’ compensation lawyer about gathering evidence for your appeal.

The Importance of Gathering Evidence for Your Appeal

You need evidence to apply for your workers’ compensation benefits. In general, you should gather all the necessary evidence before submitting your claim to get approved the first time. If your employer denies your claim, the denial letter should indicate why. A denial will delay your workers’ comp benefits.

Talk to a lawyer to make sure you have all the medical evidence you need to support your initial claim.

If the insurance carrier denies your claim, you can file an appeal. The workers’ compensation appeals process depends on your state’s law. In some states, you have to try to resolve the dispute through arbitration. In other cases, you can request a hearing with an administrative law judge (ALJ).

Unless you can reach a settlement, the ALJ can decide the outcome. If you disagree with the judge’s decision, you can file an appeal. The appeal may be your last chance to try and get your wage benefits and medical treatment.

You need all the evidence available to support your claim. You have to gather the necessary evidence with your lawyer and present it at the appeal. This includes new evidence and any evidence you never submitted with the initial claim.

Presenting New Evidence in a Workers’ Comp Appeal

When you file an appeal, you have to tell the appeals panel why the judge made the wrong decision. You can indicate what evidence has already been presented to support your claim. However, the Board of Appeals may not consider any new evidence. The appeals board may only be able to review the workers’ comp hearing decision.

If you have any new evidence, you can submit it to the workers’ compensation board with a request for reconsideration. If you have any new evidence, talk to your lawyer about your legal options. You may want to file for reconsideration before filing an appeal.

Types of Effective Evidence for a Workers’ Comp Appeal

Relevant evidence is anything that tends to prove or disprove any fact at issue in your claim. Effective evidence in a workers’ comp claim tends to show:

• Your injury was work-related
• You are unable to return to work because of the injury
• You reported your injury and filed your claim within the timeframe

To show your injury was work-related, you can provide a copy of payroll records, workplace incident reports, and emergency room records. To show the injury was reported in time, you can show email or copies of forms sent to your employer after the accident.

Collecting Medical Records

Medical records are some of the most important evidence in a workers’ comp claim. As a patient, you have the right to access your own medical records. However, some doctors and hospitals can make it difficult to get copies of your records.

Federal laws protect your record access rights. It’s easier to get a copy of your medical records with legal representation. Important medical records can include:

• Emergency department records
• Doctor’s diagnosis and treatment records
• Surgical records
• Prescriptions
• Lab results and diagnostic tests

Workers’ comp benefits include covering your medical care for the work-related injury. Medical care costs are important in your appeal. Your records should include medical expenses so you can get reimbursed after a successful appeal.

Witness Statements and Expert Reports

Witness statements from co-workers can show the injury was work-related and that it happened in the workplace. This can give the judge or appeals panel an idea of what happened around the accident. Other witness statements can show how your injuries are affecting you and that you can’t work because of the injury.

You can also get testimony or reports from experts. Medical experts can provide an expert report on how the accident caused your injuries and the accident’s consequences. Occupational experts can testify how you’re unable to work or perform the work you did before the accident. Talk to your workers’ comp attorney about getting witness statements and expert reports to support your appeal.

Responding to the Employers’ Evidence

As part of the appeals process, the workers’ compensation insurance company can also present evidence to support their claim denial. Generally, their evidence tends to show there was a reason to deny your claim or stop benefits. Your lawyer should get this evidence before the appeals hearing. Examples of the employers’ evidence can include:

• Social media posts showing you don’t appear injured
• Private investigator video showing you lifting heavy objects when you claim you can’t work
• Evidence of substance abuse on the job
• History of suspicious claims
• Differences between witness testimony and the injured worker’s statements

Legal Assistance Gathering Workers’ Comp Evidence

Presenting your case before the workers’ comp appeals board may be your last chance to get the benefits you need. An experienced workers’ comp lawyer can review your case and help you gather all the evidence you need for your appeal.

Your lawyer can work with your medical care providers to get your medical records. Your lawyer can also find experts to support your claim. Contact a workers’ comp lawyer for legal advice about gathering evidence for your appeal.