An appeal of a denied workers’ compensation claim can involve multiple agency proceedings, settlement negotiations, and a lot of time. 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’ compensation hearing is typically your only chance to present your case for why you are 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 a workers’ comp hearing, you will need to convince a judge that you are 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 your claim is properly developed and presented to the judge. Workers’ comp laws make hiring a lawyer affordable. To learn more, see our article on how much workers’ comp lawyers charge.
Before your case goes to a workers’ comp hearing before a workers’ comp judge, there typically will be other hearings and court dates. At a minimum, this usually includes a mediation and pretrial conference. At a mediation, you and the insurance company 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. Settlement negotiations may also continue at your pretrial conference. To learn more, read our article on what happens in a mediation or settlement conference.
If you have a workers’ comp lawyer, you may not need to attend all of these preliminary hearings. While you typically must attend a 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 about how to prepare for a workers’ comp hearing.
At your workers’ comp hearing, you will present your claim to a judge. Among other things, the judge will be evaluating you and how credible you are. 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 do not have to wear a suit, your clothing should be neat, clean, and respectful. A button-up shirt and slacks are appropriate.
Most workers’ comp hearings last a few hours, although complicated claims may take several days. You will be given breaks during a lengthy hearing. 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 consult with him or her beforehand.
Certain parties always attend a workers’ comp hearing:
There may be other people at your hearing, 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 a variety of documents to review. This may include:
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 do not follow the rules, the judge may not accept your documents as evidence.
At most hearings, the injured worker will testify. Typically, you will testify about:
However, in most states, there are specific rules about what you can testify about. For example, you typically cannot testify about what other people told you because this is considered inadmissible hearsay. If you make statements that are inadmissible, the insurance company’s lawyer may object—and the judge may decide not to consider this evidence.
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.
Regardless of who is asking the questions, you should answer them truthfully and accurately. If you do not know the answer, you should not 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 are rude, evasive, or dishonest, you may hurt your chances of a favorable decision.
In certain cases, 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 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 all of the exhibits and consider all of the testimony presented. You and the insurance company may also have the opportunity to submit a written brief arguing your cases. 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, or you are otherwise unhappy with the decision, you can appeal the 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.