Appealing Adverse Rulings in Workers' Compensation Defense

Many employers and providers do not realize that they can appeal determinations of workers' compensation benefits. Others simply pay the claim, fearing they will lose the appeal and waste more money in the process.

There are hundreds of issues that can be litigated in a workers' comp case. Even if you do not defeat the claim completely, a partial victory on appeal may reduce the payout by thousands of dollars over the course of an open claim.

New York Workers' Comp Appeal Attorneys

Walsh and Hacker represents workers' compensation insurance carriers and third-party administrators, as well as employers and municipalities, in appeals of controverted work injury claims. We have prevailed at all levels of appeal from administrative hearings to the appellate courts of New York, but only after a thorough case evaluation and cost-benefit analysis.

Based in Albany, we go to hearing locations throughout the Capital District, Upstate and the Hudson Valley, and we have handled workers' compensation court appeals for defense clients throughout New York State. Call 518-463-1269 or toll free 866-240-3041 to arrange a consultation.

The Workers' Compensation Appeals Process

The important consideration in appealing an adverse decision is that it is not an up-or-down, one-and-done venture. You may lose the first appeal but prevail at the next stage. You may lose the appeal on the question of liability yet defeat elements of the claim or otherwise mitigate the financial exposure.

Administrative Appeals

  • The employer/carrier/TPA can contest a workers' comp claim by formally requesting a Workers' Compensation Law Judge (WCLJ) hearing. The judge will hear testimony from both sides and decide whether the claimant is entitled to benefits.
  • Certain controverted claims may be transferred to the "Rocket Docket" for an expedited WCLJ hearing and a mandated decision within 90 days.
  • A WCLJ decision can be appealed by either side to a three-commissioner board panel of the New York State Workers' Compensation Board (WCB). The panel can consider facts as well as points of law, and it has authority to affirm, modify or rescind the WCLJ decision, or remand the case back to the hearing judge for further testimony or consideration.
  • Either side has an automatic right to appeal the board panel's decision and request a full board review by all members of the WCB. If there is one dissenting vote, a review by the full board is discretionary. The Review Bureau is the highest level of administrative appeals.

Court Appeals

  • An adverse Review Bureau ruling can be appealed to the New York Supreme Court, Appellate Division (Third Department). The Appellate Division can consider errors of law, but cannot consider new facts. The court can affirm or reverse the Worker's Compensation Board.
  • An Appellate Division decision can be appealed to the New York Court of Appeals, the highest authority in the state.

New York Workers' Comp Appeal Attorneys

Our trial lawyers have a demonstrated record of success in WCLJ hearings, WCB panels and full reviews, and we have had good wins in state court appeals. We are sensitive to the costs of appeals balanced against the potential exposure of claims that go unchallenged. We give honest counsel on the merits of appeal and the likelihood of prevailing at each level so that clients can make informed decisions. In filing a formal appeal, we also position our clients for favorable settlements to mitigate claims.

To discuss the claims, hearing and appeals process in more detail, contact our Albany office today.