What those denied work comp benefits should know about the formal hearing

Jul 29 2017

As much as we would like to think that employers and/or insurers will honor their commitments in the event an employee suffers a serious injury, this is not always the reality. Indeed, the simple truth is that injured persons may find themselves having to fight for the workers’ compensation benefits to which they are otherwise entitled.

If there is any good news to come from such a scenario it’s that the law does provide injured workers with several forums through which to attempt to resolve their concerns with an employer or insurer, including a prehearing conference, settlement conference and, of course, formal hearing.

What is the formal hearing?

In the event an injured worker and the employer/insurer are unable to reach a mutually acceptable solution concerning the amount of benefits or other issues, the matter will proceed to a formal hearing held before an administrative law judge.

At this hearing, both sides will be given the opportunity to present arguments and evidence, including sworn witness testimony and any pertinent documents.

It’s important to understand that there is no jury, but that the proceeding will be recorded by a court reporter. Furthermore, injured workers should know that a failure to attend the formal hearing could have serious consequences, such as a delay or an outright dismissal of their claim.

What’s the next step?

Once the formal hearing is completed, the ALJ will make a decision on what work comp benefits should be awarded, if any, and any other issues presented. This decision, based on the facts presented and the applicable law, will be memorialized in a written order.

A copy of the order will be mailed to both sides.

What if I wish to challenge the ALJ’s decision?

If the ALJ reaches a decision with which you don’t agree, you have the option of filing an appeal, such that the case will either be reconsidered by the ALJ or forwarded to the Industrial Claim Appeals Panel for review.

It’s important to understand, however, that a Petition to Review must be filed within 20 days from the date the order is mailed. Failure to abide by this timeline will mean the opportunity to appeal is forfeited.

What all of this serves to underscore is that the formal hearing process is extremely complex. As such, if your claim for work comp benefits has been denied and you are looking for answers, consider speaking with an experienced legal professional.