If an employee in Washington disagrees with the outcome of a workers' compensation claim (https://www.avvo.com/legal-guides/filing-workers-compensation-Washington), he or she may file a workers' compensation appeal. The Board of Industrial Insurance Appeals (http://www.biia.wa.gov/) (BIIA) reviews workers' compensation appeals. The employee, employee's doctor, or employer may appeal a workers' compensation decision to the BIIA.
Filing a workers' compensation appeal in Washington
If your workers' compensation claim was filed with the Washington State Department of Labor and Industries (http://www.lni.wa.gov/FormPub/Detail.asp?DocID=1497) (L&I), you'll receive a Notice of Decision once the claim is resolved. If your employer is self-insured, the way you'll be notified depends on the claims process. You must file an appeal to a workers' compensation claim with the BIIA within 60 days of receiving the notice. Once 60 days have passed, the decision is final and you can no longer appeal.
You must include your claim number, information about your injury or disease, reasons for disagreeing with the decision, and the relief you are requesting on your appeal.
You don't need to have a lawyer to file a workers' compensation appeal. However, these cases may be complex, and, importantly, the other parties in your appeal (your employer or L&I) will have legal counsel. To improve your chances of a satisfactory outcome, it's a good idea to hire a workers' compensation lawyer who knows the system in your state.
The workers' compensation appeal process in Washington
Once the BIIA receives your appeal, a copy is sent to L&I. If L&I reconsiders your case, the BIIA returns the case to L&I for further action. Otherwise, if the BIIA decides to hear your case, you are sent an order granting appeal.
A mediation conference is held as a first step to resolve your appeal. This is an informal meeting, either in person or on the phone, where you and the L&I representatives (or your employer) work with a mediator to seek a settlement. If a settlement is reached, or you voluntarily dismiss the appeal, the BIIA issues an order that resolves the appeal.
If the appeal isn't resolved in mediation, the case goes to court. At this point, it's critical to retain an attorney to negotiate with the opposing party, obtain witnesses, and make objections. In court, you must present evidence to show that L&I's decision (or your self-insured employer's decision) was incorrect. Your doctor will probably be required to testify on your behalf. The court will make a decision based on the medical evidence presented.
If you disagree with the court's decision, you may petition for a review of your appeal within 20 days of the court's decision. You may also appeal to a superior court within 30 days of the court's decision.
Washington State Department of Labor and Industries: Protest or Appeal a Claim Decision (http://www.lni.wa.gov/ClaimsIns/Claims/Appeals/default.asp)
Board of Industrial Insurance Appeals: The Appeal Process (http://www.biia.wa.gov/process.htm)
Related Legal Guides:
Filing for Workers' Compensation in Washington State (https://www.avvo.com/legal-guides/filing-workers-compensation-Washington)
Workplace Injuries (https://www.avvo.com/legal-guides/workplace-injuries)
Statutory Workers' Compensation (https://www.avvo.com/legal-guides/statutory-workers-compensation)
Workers' Compensation Exemption (https://www.avvo.com/legal-guides/workers-compensation-exemption)
Workers' Compensation and Social Security Benefits (https://www.avvo.com/legal-guides/workers-compensation-disability-benefits)