What is a “Trial” in Workers’ Compensation?
Most workers’ compensation claims are quickly processed and approved. However, when benefits are unjustly denied to injured workers, they often have to turn to a workers’ compensation lawyer to get the compensation they legally deserve.
This might make you wonder whether contesting a negative decision for workers’ compensation benefits means that you will go to “trial.”
What is a Workers’ Comp Trial?
A worker’s compensation case does not go to trial. It is actually an administrative hearing where a judge decides whether the claim is valid or not. Both you and the insurance company get to present evidence and witness testimony to persuade the judge on how to rule. If the judge rules in your favor, the insurance company must pay you benefits.
Keep in mind that filing for workers’ compensation benefits does not necessarily mean that you will have to go to trial. Most of these claims are approved when the injury in question is minor. However, it is not uncommon for insurance companies to deny claims that carry a detrimental monetary loss for them.
Even so, when an employer’s insurance company denies a workers’ compensation claim, an experienced attorney most often gets them to settle before the case goes to trial. This means that having a qualified workers’ comp attorney on your side is crucial to getting the benefits that you deserve.
What to Do When Your Claim Is Denied
Sometimes, insurance companies turn down workers’ comp claims unjustly. They might actually believe that there is no injury, but much too often, they do this to save money, believing that the injured worker will simply accept the decision and not appeal.
If your employer’s insurance company denies your claim for workers’ comp benefits, you should immediately contact a workers’ compensation attorney for a free consultation. The lawyer will examine the circumstances of your case and all the evidence at hand to advise you about whether appealing the decision is the right thing to do or not.
Even though appealing a negative decision can be done without an attorney, you should know that you have a right to legal counsel at every step of the process. You also stand a better chance at a favorable outcome with a workers’ comp lawyer representing you.
The Appeal Process
Appealing a negative workers’ comp claim decision is generally a four-step process. Both sides can reach a settlement during any of these steps. In fact, more often than not, a settlement is reached before these cases make it to a hearing.
The steps involved here are a conciliation meeting, a conference, a hearing, and a presentation to a review board.
Once your workers’ comp lawyer files an appeal on your behalf, the DIA (Department of Industrial Accidents) will grant a conciliation meeting within a month, although in rare cases it can take longer. This conciliation meeting will allow you and your attorney to get together with a representative from the insurance company and someone deemed a “conciliator” from the DIA to talk about the benefits being sought.
At this stage of the process, you will want to bring the following to fight your case:
- Any reports about how the accident occurred
- All medical reports pertaining to the injury sustained
- Witness names and any statements made by them
- Medical bills
Once your attorney has presented all the evidence that upholds your claim, it is probable that the insurance company’s representative will ask for additional time to investigate. If this happens, a period of up to a month might be granted.
Very few claims reach a settlement at this stage and more than one conciliation meeting could take place. However, having a workers’ comp lawyer on your side increases your chances of getting the insurance company to agree to a settlement during a conciliation meeting.
If a settlement is not reached during the conciliation meeting stage, the process continues to a conference proceeding. This is a formal meeting involving you and your attorney as well as an attorney for the insurance company and an administrative judge.
Whatever disputes there might be about your claim will be discussed during the conference proceeding. If the disputes in question are settled, the judge will decide what benefits should be granted or not and whether there should be modifications or not.
Most cases are usually settled by this stage. However, if your workers’ comp claim is denied at this point, your lawyer can appeal within 14 days and a hearing will proceed.
A workers’ comp hearing is a legal proceeding that people often think of as a trial. However, a hearing is not conducted in a courtroom and there is no jury. But a judge does preside over a worker’s comp hearing.
Both your workers’ comp lawyer and the insurance company’s legal representative will be able to introduce any relevant evidence and witness testimony to persuade the judge about whether benefits should be awarded or not.
The judge will consider everything presented at the trial and a decision will be made, usually within 30 days but this could take longer. Either side can file an appeal to a review board.
Very few workers’ compensation cases make it to the review board. This panel is presided by three judges who carefully consider all transcripts from the hearing, briefs from both parties involved, and often call for oral arguments. Once the judges have taken everything into account, they will decide whether the decision from the hearing should stand, to reverse, or modify it in some way.
This is often the final step in a workers’ comp “trial.” However, However, if either of the two parties in the case is still not happy with the decision, they can still appeal to a higher court, but this only happens in extreme cases.
Contact A Workers’ Comp Lawyer
Workers’ comp cases tend to be simple and straightforward, but when insurance companies stand to lose a significant amount of money, they can complicate things significantly. Having an experienced attorney who can guide you through every step of the process is imperative. The best thing that you can do, especially if your claim has been denied, is to contact us at (617) 523-2929 today.