Workers' comp judges frequently order mediation and settlement conferences before a formal hearing is scheduled in a workers' comp case. These conferences are forms of alternative dispute resolution, which can help you and your employer (or its insurance company) reach a settlement.
Some states require mediation, while in other states it's voluntary. Because many claims are resolved during mediation, you will want to be well prepared.
A mediation or settlement conference is an informal negotiation process—you will not testify under oath or present witnesses. Instead, you and the insurance company will discuss the claim and make settlement offers with the help of a trained, neutral third party (the mediator). The mediator may be an experienced workers' comp lawyer, a representative from the state workers' comp agency, or a workers' compensation judge.
The mediation process varies from state to state. In some states, mediation is a short meeting where a mediator sits with you and a representative of the insurance company to informally discuss the case.
If you and the insurance company cannot agree on a settlement, your appeal will progress to the next stage (typically a formal hearing). If you do reach an agreement at mediation, you will sign a settlement agreement and your case will be resolved. (To learn more, see our article on the different types of settlement agreements.)
In other states, mediation is more detailed and lengthy. The mediator might begin by asking you and the insurance company to summarize your claim and legal arguments.
The mediator might then ask questions and point out the strengths and weaknesses on both sides. The mediator will usually then separate the parties into different rooms for private discussions.
After these conversations, the mediator might make a settlement recommendation. If you and the insurance company cannot agree on a settlement, your claim will be set for hearing.
In some states, mediation and settlement conferences are different processes. For example, in Michigan, mediation is typically used for medical-only claims and claims involving an unrepresented worker.
A representative from the state workers' compensation agency mediates these disputes. Typically, a state mediator will try to resolve the dispute but will not recommend a settlement value.
A more detailed settlement conference is also required in almost every Michigan workers' comp appeal. At this conference, both you and the insurance company present arguments, and a judge will evaluate your claim's settlement value.
An injured worker is not required to a have a workers' compensation lawyer. However, mediation requires a detailed legal analysis of the claim, the calculation of unpaid benefits, and negotiation skills.
It can be difficult for an injured worker to fully prepare a workers' comp claim alone. Unless your claim is very simple, you should consider contacting a workers' compensation lawyer for assistance before you attend mediation or settlement conference.
By signing a settlement agreement, you are giving up important rights in your workers' comp case. An experienced lawyer can guide you through the mediation process and make sure you are receiving a fair workers' comp settlement. (For more information, see our article on whether you need a workers' comp lawyer.)
A large percentage of cases that go to mediation settle. However, your level of preparation can have a big impact on the result you get at mediation. If you're unfamiliar with the legal issues in your case or the amount of benefits you are owed, your claim might be undervalued at mediation—meaning you won't get as much compensation as you deserve.
Below are some tips on how to prepare for mediation. Some of these tasks will be handled by your workers' compensation lawyer, if you hire one.
To start, you should put together a file containing all of the evidence in your workers' comp claim, including copies of your medical records. At mediation, you (or your lawyer) will probably have to explain the medical issues and discuss the evidence supporting your claim for benefits.
Next, you should calculate your amounts of unpaid medical bills and wage loss benefits. The mediator will need to know how much the insurance company may owe you before making a settlement recommendation.
You'll also need to understand how much you might be owed before you negotiate with the insurance company. If you don't have a good understanding of your claim's financial value, you'll be at a serious disadvantage during a mediation or settlement conference. It is usually in your best interest to hire a workers' comp lawyer to help calculate the value of your claim.
Most mediation hearings are scheduled for a set period of time. If you're late, you might be unable to complete the mediation process. Additionally, the mediator and the insurance company are assessing your credibility. Showing up late may indicate that you do not take your claim seriously. It is best to arrive early.
Your workers' comp lawyer, if you've hired one, will also want to meet with you before the actual mediation to prepare and discuss your claim.
Workers' comp appeals can be stressful. However, you should do your best to remain polite and professional throughout the mediation. Try to focus on the facts of your case rather than your frustration with the insurance company. Mediators and judges evaluate claims based on evidence, not your emotions. However, this doesn't mean you have to agree with everything the insurance company says. Instead, have evidence prepared that supports your claim. If you have a lawyer, he or she will guide you through the process and help you present professional and fact-based arguments.
Additionally, the mediator and the insurance company will evaluate your credibility. The insurance company will be more interested in settlement if your statements are believable and consistent with the evidence. (Most insurance companies would rather settle claims than risk losing at a hearing.)
While you don't need to wear a suit to your mediation or settlement conference, you should be neat and clean. Mediation is an informal process and you may dress casually. Jeans and a button up shirt are usually acceptable. If you have a lawyer, check with him or her about what to wear beforehand.
If you came to an agreement with the insurer at mediation, you'll be sent paperwork to finalize the settlement and your benefits will start within a few weeks or months.
If you couldn't agree on a settlement with the insurance carrier, your case will proceed to a hearing in front of a workers' comp judge, although you can still come to a settlement agreement before the hearing takes place.
Mediation is a critical stage of the workers' comp process. Not surprisingly, most people find it helpful to have an attorney on their side to help them navigate this process. Workers' comp attorneys typically charge a fee only if you win your case, so hiring one requires no money up-front.