Hearings in Workers’ Compensation Cases

In the Commonwealth of Massachusetts, the workers’ compensation system is governed by Title XXI Labor and Industries Chapter 152, which is commonly referred to as the Workers’ Compensation Act.

In this Boston workers’ compensation claimant resource page, we will primarily be discussing what happens at a hearing in the workers’ compensation appeals process. However, to put this information in context, it will be necessary to briefly review the process from the time an injury occurs at work until the time of the hearing.

After the filing of a conference appeal, hearings are scheduled and held pursuant to Title 152 of Title XXI, Section 11. It is typically very difficult to represent yourself at a hearing and it is highly recommended that you have an experienced workers’ compensation attorney fighting for you. Not only will the insurer have an attorney representing their interests, but you will also be required to have a grasp on the Massachusetts Rules of Evidence. You will also have to deal with being cross-examined, and it will help if you have someone on your side fighting for your right to a full and appropriate award of workers’ compensation benefits.

Once the hearing has concluded, the judge has 28 days to issue a decision, although sometimes it can take significantly longer. Again, this can be a decision to either issue weekly workers’ compensation benefits or to deny them. Even though this is a hearing before the same AJ, the AJ can consider evidence not covered during the conference.

If one party does not agree with the decision in a workers’ compensation hearing before an AJ, the party will have 30 days to file an appeal and request to be heard before the reviewing board. This can get very complex, and the requesting party must pay a fee of at least one-third of the weekly wage that would have been awarded. This fee must be paid prior to the hearing. However, there is also a provision in Section 11C that states if the party making the request is an indigent claimant, the fee can be waived. This is something an experienced legal team can assist with.

When an accident occurs at work, it is very important to report it to your supervisor. Some people are worried they will get in trouble if they report the accident, so they try to deal with the pain without seeking medical attention. This is not the right thing to do and can greatly jeopardize your workers’ compensation rights in the future. It is essential to report the accident to your employer and seek prompt medical attention.

The law prohibits an employer from taking retaliatory action against an employee who reports a workplace injury. Retaliation can include wrongful termination or any other type of discipline or harassment.

You might not know the full extent of your injury at the time of the accident. For example, you may initially think the injury is not that bad, but it may become much worse in the following days. If an employee did not report the accident when it actually occurred, the employer or its workers’ compensation insurance company may try to claim the accident occurred while the employee was not working and, therefore, the insurer is not liable to provide workers’ compensation benefits.

As our Boston workers’ compensation attorneys can explain, failing to make an immediate report of your workplace injury does not mean that you will not be able to obtain a full and appropriate workers’ compensation award, but it often does result in a more complex case. There are other ways to prove the accident occurred at work, and having an experienced workers’ compensation attorney on your side is the best way to ensure your rights are protected. For example, in some cases, there will be coworkers who can testify as to what they witnessed, or there may be security cameras that captured what happened.

Once you have reported your accident, your employer has seven days to report the accident to its workers’ compensation insurance carrier. At this point, the insurance company has 14 to 30 days to make a decision. They can either accept the case on a preliminary basis and begin making workers’ compensation payments, or deny the case.

If the workers’ compensation insurance company has denied your claim, you should immediately contact an experienced on-the-job accident attorney in Boston. While you are not required to have an attorney, the Massachusetts Department of Industrial Accidents (DIA) strongly recommends that you get one. You should also take comfort in the fact that you will not need to pay any legal fees unless you collect workers’ compensation.

If your employer’s workers’ compensation insurance company has denied your claim, you must file a claim with the DIA in order to collect workers’ compensation benefits. This is something your attorney can assist you with. Once the claim has been filed, you will be required to go through the conciliation process. A conciliator is hired by the DIA to hear your argument for why you should get workers’ compensation benefits and will hear the insurer’s reason for denying the claim. The conciliator has no power to order the parties to settle or to make any type of order, but the goal of a conciliator is to encourage and facilitate agreements between the parties. An agreement can consist of paying monthly benefits, resolving the case through a one-time lump sum payment, or some combination of both.

If the conciliation process does not result in an agreement, the claim will be referred for assignment to an administrative judge (AJ). An administrative judge in workers’ compensation cases works for the DIA and is there to be an impartial arbitrator. The first thing that will happen after it is assigned to an AJ is that a date will be set for a conference to take place. A conference is an informal hearing where the parties are required to present evidence and argue their case. However, as this is an informal process, the rules of evidence do not apply.

While this is considered an informal process, the employer or its workers’ compensation insurance company will likely have an attorney representing them. Their goal will be to not pay you the benefits to which you are lawfully entitled. It is best to have an experienced attorney of your own.

At the conference, after the AJ listens to the evidence, he or she will have up to seven days to file either a written order that denies weekly workers’ compensation benefits or an order that the benefits be paid. The AJ also has the power to issue a modification to an existing workers’ compensation award.

If the AJ issues a written order denying the workers’ compensation benefits, the claimant has fourteen days to file an appeal and to request for a hearing. The hearing will be before the same AJ that issued the order, but it will be a much more formal proceeding. It should be noted that either party could file an appeal of a conference decision. We have seen many cases where the workers’ compensation insurance company does not agree with the award of weekly workers’ compensation benefits and files an appeal for a hearing before that AJ. There are also cases in which both you and the insurance company disagree with the judge’s decision and as a result, both parties file appeals.

Contact the Jeffrey Glassman Injury Lawyers today for a free and confidential consultation.