Workers’ Compensation Hearings
It’s quite common for a workers’ compensation claim, or a portion of a claim, to be disputed. An insurance carrier may deny a claim because an injury wasn’t work-related or wasn’t promptly reported. The injured worker and the insurance company may disagree on whether a particular medical treatment is “reasonable and necessary” or about the extent of a worker’s disability.
Every state has a process to resolve these kinds of disputes, which involves a variety of administrative hearings.
Issues that are decided at a workers’ compensation hearing
Again, the rules pertaining to hearings vary from state to state. Some states require every issue to be settled at a single hearing, while others allow for a series of hearings. The main issues that may be resolved in a hearing include:
- Whether a particular injury really is work-related
- Whether a particular injury is new or merely an aggravation of a pre-existing injury
- How to calculate the employee’s average weekly wage
- The extent of the employee’s disability
- Whether a particular medical treatment is reasonable and should be covered by workers’ comp
What to expect at a workers’ compensation hearing
A workers’ comp hearing is a less formal process than a jury trial. Typically, there are only a small number of people in the room: the judge, the injured worker and their lawyer, the insurance company’s lawyer, a court reporter, any witnesses, and perhaps a representative from the employer and/or the insurance company.
During a hearing, evidence is presented for the judge to consider. This may include:
- Medical treatment records
- Medical and pharmacy bills
- Evidence of lost wages, such as paystubs
- Employment and personnel records
- Depositions and reports from experts, such as the injured worker’s treating physician or a vocational expert
- If relevant to the case, documents showing a job search or other employment action
Each state has its own rules for what types of evidence can be submitted in a hearing. During the hearing itself, the injured worker and any witnesses will testify under oath, including cross-examination by the other side’s attorney.
Typically, a judge will not make an immediate decision in a workers’ comp hearing. Instead, the decision will be issued in writing in 30 to 90 days.
What comes after the hearing process?
If the injured worker is not happy with the judge’s decision, every state has an appeals process. The specific body or bodies that hear appeals vary from state to state, as do the deadlines to file an appeal – some as short as two weeks from the decision. As such, it’s important for injured workers to act quickly to preserve their legal rights and continue to pursue the compensation they need.
While it is technically possible to go through the hearing process without a lawyer, it’s not in the worker’s interest to do so. Workers’ compensation is a highly technical area of law, and an experienced attorney knows the applicable rules, regulations and precedents to fight for a successful outcome in a hearing or, if necessary, an appeal. Most workers’ compensation lawyers offer free consultations and work on a contingency fee basis, so there is no reason not to at least talk to an attorney about your legal rights and options after a work injury.
