While many disputed workers' comp claims are settled, others require a formal hearing before a workers' comp judge in order to be resolved. At this hearing, the judge will review all of your evidence and then issue a decision awarding or denying your benefits. Because a workers' comp hearing involves specific rules and procedures, it is important to be well-prepared.
Unless your claim involves a simple issue, like a minor, medical-only dispute, you should seriously consider hiring a lawyer. Workers' comp claims require a detailed understanding of legal and medical issues. You will have to review medical records, participate in depositions, and build your case for benefits. As workers' comp laws have been reformed, this has become an increasingly complex process that involves multiple experts and a detailed medical analysis.
A workers' comp lawyer will ensure that you and your claim are properly prepared for the hearing. A lawyer can also help you negotiate with the insurance company—potentially avoiding the need for a hearing at all. (See our lawyer directory for workers' comp lawyers in your community.)
If you decide not to hire a lawyer, you will need to thoroughly prepare for the hearing. In particular, you will need to get copies of your medical records, unpaid medical bills, and other documents supporting your claim. In most states, you must participate in a "discovery" process with the insurance company. During discovery, you and the insurance company will exchange documents and information. You must follow your state's rules about sharing and submitting evidence. If you do not follow these rules, you might be prohibited from presenting the evidence to the judge at your hearing.
You usually cannot win a workers' comp appeal without fact-based evidence (such as medical records). The judge must follow specific rules when evaluating your claim. For example, you typically cannot get workers' compensation without a formal medical diagnosis from a doctor. Your own testimony that you experience pain is insufficient. You must have medical records and diagnostic studies (such as an MRI, X-ray, or EMG) that support your claim.
In addition to your treating doctor's medical records, the doctor can make formal recommendations about your claim. For example, you may submit a written report from your doctor summarizing your injuries, restrictions, and your ability to work. However, the insurance company usually has the right to question your doctor about his or her opinions.
Frequently, the insurance company will schedule you for an independent medical examination (IME) by a doctor of its own choosing. An IME doctor will review your medical records, perform an examination, and write a report summarizing his or her findings. While some IME doctors are truly independent and neutral, others consistently write reports supporting the insurance company. If the insurance company schedules an IME, you must attend the appointment. To learn more, read our article about attending an IME.
In a workers' comp appeal, you can demand payment of your medical bills, wage loss, and other benefits. Before your hearing, you should organize your unpaid medical bills and calculate how much you need to pay them off. You should also calculate your lost wages and prepare paystubs and other evidence to support your claim. Finally, you should calculate how much you are owed in permanent disability benefits. (For help understanding how benefits are calculated in your state, see our state articles on workers' comp benefits.) The judge will need this information in order to awards benefits.
In some states, you also must prove that your injuries reduce your ability to earn wages. This is often done by hiring a vocational expert to explain how your injuries have impacted your ability to find work and earn wages. A vocational expert will evaluate your education and work experience and identify jobs that you are able to perform. The expert will issue a report discussing these issues and may describe your post-injury earning potential. While some vocational experts are truly neutral, others tend to support whoever pays for the evaluation. For example, the insurance company's expert will typically argue that you have little to no reduction in wage-earning capacity.
Expert witnesses and depositions are part of almost every workers' compensation appeal. It is very difficult to win a workers' comp claim without expert witnesses. These witnesses may include treating doctors, independent medical examiners, and vocational experts.
In a workers' comp claim, most expert testimony is obtained at a deposition. A deposition is testimony taken under oath. Your lawyer (and the insurance company's lawyer) will ask the expert questions while a court reporter transcribes (or types out) their questions and answers. For example, during the deposition of an IME doctor, the insurance company's lawyer will question the doctor to elicit his or her opinions. Then, your lawyer will cross-examine the IME doctor and attempt to weaken or discredit the doctor's opinions. At your hearing, the transcribed conversation is given to the judge as evidence.
In certain states, injured workers are also deposed. If your deposition is scheduled, you should be well-prepared. Make sure your answers are truthful and accurate—your transcribed testimony can be presented to the judge by the insurance company. If you have a workers' comp lawyer, he or she will also be at your deposition and will guide you through the process. To learn more, see our article about preparing for your workers' comp deposition.
Sometimes, you may want to present other witnesses at your workers' comp hearing, including coworkers who witnessed your accident. Before your hearing, confirm that your witnesses are willing to testify and give them the time and date of your hearing. Your workers' comp lawyer may also want to meet with these witnesses and help them prepare for their testimony.
Testifying at a hearing is different than having a casual conversation with someone. When you testify, you will be asked questions—and you must be prepared to answer them. You also must follow your state's evidentiary rules. For example, you typically cannot testify about things other people told you because of the hearsay rule. Instead, you may only testify about things you saw, experienced, or said.
Before your hearing, organize your thoughts. You may want to write down a timeline of your claim, including:
It is important to provide accurate and honest information at your hearing. You should not exaggerate (or minimize) your injuries or physical limitations. If the workers' comp judge questions your credibility, he or she may deny your claim.
On the day of your hearing, you should dress neatly and cleanly. A button up shirt and slacks are appropriate. You should also give yourself extra time to travel to the hearing location because it's important that you arrive on time. For more information about the workers' compensation hearing process, see our article on what to expect at a workers' comp hearing.