Any Denial is Appealable
In Oregon, an injured worker is allowed to appeal any denial or underpayment of benefits with a workers' compensation claim.
For example, if a claim is denied, the injured worker can request a hearing. This request is then sent to the Workers' Compensation Board Hearings Division. Depending on the issues, the injured worker appears at a live hearing, where exhibits are submitted, witnesses are called, and arguments are made. The Administrative Law Judge ("ALJ") that hears the case will issue an Opinion and Order. This is a written decision, and the Administrative Law Judge will decide whether or not the denial should be affirmed, or set aside. Either party can appeal from this Order.
Appealing an Opinion and Order
The appeal of an Opinion and Order goes to the Workers' Compensation Board. When an insurance company or an injured worker seeks board review, a transcript of the hearing is prepared and provided to both parties. The Board then issues a briefing schedule. The appealing party gets to file an opening brief, which is simply a written argument explaining why the Administrative Law Judge should not have ruled the way he or she did at the hearing. The non-appealing party gets to write a response brief, and finally, the appealing party gets the last say with a reply brief.
The Order on Review
The Workers' Compensation Board then assigns Board Members to review the case and issue an Order on Review. An Order on Review is another written decision that outlines whether the Board agrees with the Administrative Law Judge, or not. If the issue is whether a claim denial should a been affirmed or set aside, the Board will review the case "de novo." This simply means that the Board is taking a brand-new look at the case, and for the most part, will reweigh most of the evidence that the Administrative Law Judge reviewed. Just think of kids playing football allowing a "do-over."
Sometimes, the ALJ or the Board will interpret a part of the workers' compensation statute in a certain way. The injured worker may not agree with the way the ALJ or Board interprets a statute, and then will go one step further to the Oregon Court of Appeals.
We offer experience and insight helping you with denied claims, and preparing for a hearing. If you have an open workers' compensation claim or a denied claim, and you want to know your options, contact us. We can look at your file, and let you know where you stand.