If you've had an on-the-job injury or illness, but your workers' comp claim was denied, you have the right to appeal that decision. You should know, however, that the process may involve several proceedings, settlement negotiations, and a lot of time. You may also have to go through an independent medical exam.
If you're not able to resolve the dispute informally through a settlement, a judge will schedule a formal hearing and issue a decision in your case. A formal workers' comp hearing is typically your only chance to present your case in front of a judge and show why you're entitled to benefits, so it's important to understand the process and rules involved.
For many injured workers, a workers' comp hearing is too difficult to handle on their own. At this hearing, you will need to convince a judge that you're entitled to a certain amount of workers' comp benefits, by making legal arguments and presenting evidence.
You should seriously consider hiring an experienced workers' compensation lawyer to represent you at your hearing. A lawyer will make sure that you have the proper evidence to show the judge. Workers' comp laws make hiring a lawyer affordable. To learn more, see our articles on how much workers' comp lawyers charge and what a good workers' comp attorney should do.
Before your case goes to a hearing with a workers' comp judge, there typically will be other proceedings and court dates. At a minimum, this usually includes mediation and a pretrial conference. During mediation, you and the insurance company (and your lawyer, if you have one) will try to negotiate a settlement with the help of a neutral third party. At a pretrial conference, you may exchange information with the insurance company's lawyers and the judge. You may also continue trying to negotiate a settlement. To learn more, read our article on what happens in workers' comp mediation and settlement conferences.
If you have a workers' comp lawyer, you may not need to attend all of these preliminary hearings. While you typically must attend mediation, your presence may be unnecessary at a pretrial conference. Check with your lawyer to see if you need to be there.
Before you attend your workers' comp hearing, you should organize your evidence—including medical records, unpaid medical bills, doctors' reports, and other documents. You should also mentally prepare to testify. If you have a workers' comp lawyer, your lawyer should meet with you beforehand to discuss your claim and help prepare you to testify at the hearing. To learn more, see our article on how to prepare for a workers' comp hearing.
At your workers' comp hearing, you will present your case to a judge. Among other things, the judge will evaluate whether you should be believed. It's important to be polite and respectful at all times. You should also be on time for your hearing and appropriately dressed. Although you don't have to wear a suit or business attire, your clothing should be neat, clean, and respectful.
Most workers' comp hearings last a few hours, although complicated claims may take several days. If the hearing is long, the judge will give you breaks. On the day of your hearing, you should bring any medications or items you may need for the day (such as a heating pad or TENS unit for pain relief). Your lawyer may have more specific instructions, so be sure to ask beforehand.
Certain people always attend a workers' comp hearing:
Other people may also be there, including a court reporter (who will type a transcript of the hearing), witnesses (including coworkers, supervisors, and doctors and other experts), a representative from your employer, and an insurance company representative.
At the beginning of the hearing, you and the insurance company will give the judge documents (or "exhibits") to review, including:
Most states have specific rules about what you can give the judge. For example, you typically must let the insurance company's lawyer know what records you plan to submit and provide the lawyer with copies in advance of your hearing. If you don't follow the rules, the judge may not accept your documents as evidence.
You will usually testify at the hearing. Typically, your testimony will include:
Before you testify, the judge will put you under oath to tell the truth. Then, your workers' comp lawyer will ask you a series of questions. Once your lawyer is finished questioning you, the insurance company's lawyer will have a chance to ask you additional questions (called a "cross-examination"). The judge might also ask you questions.
No matter who is asking the questions, you should answer them truthfully and accurately. If you don't know the answer, don't guess. Instead, simply say, "I don't know" or "I can't remember." During your testimony, the judge is not only looking for factual information but is also assessing your credibility. If you're rude, evasive, or dishonest, you may hurt your chances of a favorable decision.
Most states have specific rules limiting what you can say in your testimony. For example, you typically aren't allowed to testify about what other people told you, because this is considered hearsay. If you make statements that inadmissible (meaning they aren't allowed as evidence), the insurance company's lawyer may object—and the judge may decide not to consider this evidence.
Sometimes, both you and the insurance company may want to present other witnesses. These witnesses may include coworkers who saw your accident, the insurance adjuster who denied your claim, and experts.
Most of the time, doctors give their testimony ahead of time at a deposition (where the doctor's sworn testimony is typed out) rather than at the hearing. However, you might have vocational and other experts testify in person. (A vocational expert evaluates your ability to find other work and may be necessary in some states.)
Both you and the insurance company will have a chance to ask these witnesses questions.
The judge usually will not make a decision at your hearing. Instead, the judge will review the exhibits and consider all of the testimony. You and the insurance company may also have the opportunity to submit a written brief with arguments to support your side of the case.
After reviewing all of this information, the judge will write a decision that will be mailed to you, your workers' comp lawyer, and the insurance company. Typically, judges issue decisions within 30 to 90 days.
If the judge rules against you, you can appeal that decision. The appeal process and filing deadlines vary from state to state, but they may be as short as a week or two. If you need help, contact an experienced workers' comp lawyer or your state agency.