Appealing an Arkansas Workers' Compensation Denial
Find out how to appeal a denied workers' comp claim in Arkansas.
If you have been denied workers’ compensation benefits, or your employer or its insurance company is disputing any portion of your claim, you may want file an appeal with the Arkansas Workers’ Compensation Commission. This article will explain how to file an appeal, what the appeals process is like, and how to file further appeals if your initial appeal is denied. (For an overview of eligibility and benefits, see our overview article on Arkansas workers' comp claims.)
How to File an Appeal
If you disagree with a decision that has been made in your case, you can file an appeal with the Arkansas Workers’ Compensation Commission. You may do so by submitting a “Claim for Compensation” (Form AR-C) with the Commission, or by sending a letter to the Commission requesting a formal hearing. If you choose to send a letter, it should clearly state the date of your injury, what benefits you have already received (if any), what benefits you are seeking, and what issues are in dispute.
There are strict time limits for when an employee may file a claim for compensation with the Commission:
- Accidental injuries: two years from the date of your injury or, if you have received any workers’ comp benefits, one year from the time that you last received any compensation.
- Occupational diseases: one year from your last “injurious” exposure to the substance that caused your disease. An injurious exposure is an exposure that actually caused or contributed to your disease. For example, if you worked with a chemical that caused you develop cancer, you have one year from your last exposure to that chemical. Special time limits apply to certain diseases, such as asbestosis or silicosis, and to injuries caused by exposure to X-rays, radioactive substances, or ionizing radiation.
Typically within a couple of days of filing your claim, an Administrative Law Judge (ALJ) will be assigned to your claim and will send both sides a notice that the claim has been received. Your employer or its insurance company has 20 days from receiving the notice to respond to your claim. Because most employers have workers’ compensation insurance with third party companies, you will most likely be dealing with the insurance company throughout the appeals process.
The Commission provides mediation services to give you and the insurance company an opportunity to resolve your dispute before a hearing. Mediation is optional for most claims, but it is mandatory if your claim is for less than $2,500. The Commission will assign a Legal Advisor to conduct the mediation. Mediation is an informal conference that usually lasts a couple of hours. During mediation, the Legal Advisor will try to help the parties reach an agreement on how to settle the dispute. If you and the insurance company cannot come to an agreement, your case will continue on to trial.
If you don’t want to participate in mediation, or mediation is unsuccessful, you can proceed to a formal hearing before the ALJ. Unlike the Legal Advisor in a mediation, the ALJ will issue a binding decision after the hearing.
Before the Hearing
You may be required to exchange medical reports, accident reports, or other evidence with the insurance company before the hearing (this process is known as “discovery”). In addition, you may have to attend a deposition: a question and answer session in which a witness must testify under oath. At your deposition, the attorney for the insurance company will ask you questions about your injury or disease, as well as prior injuries or illnesses, your hobbies or other off-duty activities, and your educational and occupational background. Your treating physicians and any witnesses to the accident may also be deposed.
You may also have to complete some prehearing procedures with the Commission. You may be required to fill out a prehearing questionnaire about the status of your claim and what benefits you are seeking. The ALJ assigned to your claim may also conduct a prehearing conference. During the conference, the ALJ will set the date for the hearing, determine the scope of the issues in dispute at the hearing, and ask each side what evidence or witnesses will be presented at the hearing.
During the Hearing
The Workers’ Compensation Commission has hearing locations in every county. Your hearing will most likely take place in the county where your injury occurred. A workers’ compensation hearing is much less formal than a trial in court. Although there are still procedure rules, they are much more relaxed. Most hearings take less than an hour.
During the hearing, both sides will have an opportunity to present their cases. The lawyers will summarize medical evidence, review witness statements or other accident reports, and make legal arguments. They may question you as well as any witnesses who have appeared for the hearing.
During the hearing, you should act respectfully and politely toward the ALJ, your employer, the insurance company, and its attorney. While you may believe that you are being treated unfairly, being outwardly hostile will not help your claim. Listen carefully to the proceedings and do not speak during the hearing unless you are asked to do so.
After the hearing, the ALJ will issue a written order with his or her decision on the dispute. If you disagree with the ALJ’s decision, you may file an appeal within 30 days with the full Workers’ Compensation Commission, which is a panel of judges. To file an appeal, you can send a letter to the Commission, specifically stating what issues from the ALJ’s order you wish to appeal. Once you file your appeal, you have 30 days to file a brief supporting your appeal.
If you disagree with the full Workers’ Compensation Commission’s decision, you may file an appeal with the Arkansas Court of Appeals within 30 days. Appeals with the Court of Appeals are subject to the Arkansas Rules of Civil Procedure.
Consult a Lawyer
If you believe that your employer or its insurance company is not handling your workers’ compensation claim appropriately, or your claim is scheduled for a hearing, you should contact an attorney. Because of the strict time limits on filing claims, the number of pre-hearing procedures you may have to complete, as well as the necessity of presenting legal arguments and evidence at your hearing, you should consider hiring a workers’ compensation attorney to represent you. An attorney will give you the best chance of collecting all the benefits you are entitled to. See Nolo’s lawyer directory for experienced workers’ compensation attorneys in your area.