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Who Decides Workers’ Comp Claims?

Many people are confused by the process of resolving disputed workers’ compensation cases. Because it is often referred to as “litigation,” they assume that workers’ comp cases are presented and decided in the same manner as civil cases such as those involving personal injury and breach of contract.

Workers’ compensation cases are not generally litigated in California’s courts of general jurisdiction and instead proceed through a specialized administrative process in front of specialized administrative judges. Although they may ultimately enter the regular court system as appeals, even then they are governed by special standards of review that distinguish them from other cases.

Workers’ compensation is not a government benefit. It is paid by private insurers hired by individual employers. However, the government does closely regulate when claims are payable by an administrative process that begins with the CA Department of Industrial Relations, Division of Workers’ Compensation.

  • When an insurer or self-insured employer denies a workers’ compensation claim or offers a benefit less than that to which an employee is entitled, the case is submitted to an administrative law judge of the DWC. These judges conduct what are essentially bench trials that allow the presentation of witness testimony and documentary evidence, which is subject to the same rules of evidence used in trial courts. After hearing the evidence, these judges render a decision.
  • If either party disagrees, it can make an administrative appeal to the CA Workers’ Compensation Appeal Board. While this is not a court, it functions in the same way. It reviews the record of the evidence as well as the arguments of both parties, and decides whether to reverse or affirm the judge’s decision.
  • A party that disagrees with the WCAB’s decision may take the case to the appropriate California Court of Appeal. From there, it follows the normal course through the state court system.

An Orange County workers’ compensation attorney’s goal is to get a fair decision as early as possible. However, claimants still have options even after being disappointed at the trial level.

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